Abstract
PurposeThe purpose of this study was to investigate whether the cardiac motion artifact that regularly appears in diffusion-weighted imaging of the left liver lobe might be reduced by acquiring images in inspiration, when the coupling between heart and liver might be minimal.Materials and methods43 patients with known or suspected focal liver lesions were examined at 1.5 T with breath hold acquisition, once in inspiration and once in expiration. Data were acquired with a diffusion-weighted echo planar imaging sequence and two b-values (b50 = 50 s/mm² and b800 = 800 s/mm²). The severity of the cardiac motion artifact in the left liver lobe was rated by two experienced radiologists for both b-values with a 5 point Likert scale. Additionally, the normalized signal S(b800)/S(b50) in the left liver lobe was computed. The Wilcoxon signed-rank test was used comparing the scores of the two readers obtained in inspiration and expiration, and to compare the normalized signal in inspiration and expiration.ResultsThe normalized signal in inspiration was slightly higher than in expiration (0.349±0.077 vs 0.336±0.058), which would indicate a slight reduction of the cardiac motion artifact, but this difference was not significant (p = 0.24). In the qualitative evaluation, the readers did not observe a significant difference for b50 (reader 1: p = 0.61; reader 2: p = 0.18). For b800, reader 1 observed a significant difference of small effect size favouring expiration (p = 0.03 with a difference of mean Likert scores of 0.27), while reader 2 observed no significant difference (p = 0.62).ConclusionAcquiring the data in inspiration does not lead to a markedly reduced cardiac motion artifact in diffusion-weighted imaging of the left liver lobe and is in this regard not to be preferred over acquiring the data in expiration.
Highlights
Diffusion weighted imaging (DWI) has been used widely for the detection of different pathologies of the liver, e.g. for the characterization of liver fibrosis and liver tumors, or the detection of liver metastases [1,2,3,4,5]
The normalized signal in inspiration was slightly higher than in expiration (0.349±0.077 vs 0.336±0.058), which would indicate a slight reduction of the cardiac motion artifact, but this difference was not significant (p = 0.24)
Breathing motion leads to the so-called stair-step artifacts [11], blurred images and a reduced sharpness, whereas the pulsation artifact originating from cardiac motion leads to a decreased or vanishing signal in the left liver lobe [9]
Summary
Diffusion weighted imaging (DWI) has been used widely for the detection of different pathologies of the liver, e.g. for the characterization of liver fibrosis and liver tumors, or the detection of liver metastases [1,2,3,4,5]. They mostly arise from two sources, breathing and cardiac motion [8,9,10]. Breathing motion leads to the so-called stair-step artifacts [11], blurred images and a reduced sharpness, whereas the pulsation artifact originating from cardiac motion leads to a decreased or vanishing signal in the left liver lobe [9]. Different approaches were investigated to reduce the pulsation artifact that partially build on advanced diffusion sequences like flow-compensated sequences [17, 18], which are not widely available and, more importantly, have drawbacks like a reduced b-value efficiency or a worsened black-blood contrast
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