Relevance of lesion size in navigator-triggered and free-breathing diffusion-weighted liver MRI.

Abstract

The purpose of this study was to investigate the relevance of focal liver lesions (FLL) size for lesion detection comparing navigator triggering (TRIG) to free breathing (FB) liver Diffusion-weighted magnetic resonance imaging (DWI). Patients with known or suspected FLL were prospectively (registry number 276_19 B) included from October to December 2019 in this study, out of which 32 had liver lesions. Echo planar spin-echo DWI data both with TRIG and FB were with approximately constant acquisition times acquired at 1.5 T. Lesions were segmented in the b = 800 s/mm² images in both the TRIG and FB images. The lesion size, location (liver segment), liver lesion visibility, as well as contrast-to-noise ratio (CNR) were recorded. The CNR was assessed with the Wilcoxon-Mann-Whitney test and the number of visible lesions with the Fisher test. Data from 43 patients (22 female) were analyzed. The mean patient age was 58 ± 14 years. A total of 885 FLL (Ntotal) were segmented. Among these, 811 lesions (Nboth) were detected with TRIG and FB, 65 lesions exclusively with TRIG (NTRIG_Only), and nine exclusively in FB (NFB_Only). The largest additional lesion in TRIG/FB had a diameter of 10.4 mm/7.6 mm. The number of additional lesions detected with TRIG decreased with size. Among all lesions ≤ 4.7 mm, the relative number of additional lesions was 15.6%. Additional lesions were found in all liver segments with TRIG. In the left liver lobe, the relative proportion was 9.2%, and in the right liver lobe 5.4%. CNR and visibility were significantly higher in TRIG than in FB (p < 0.001). In relation to size, the difference is significant in terms of visibility and CNR for lesion diameters ≤ 8 mm. Respiration triggering can improve the detection of small liver lesions with diameters up to approx. 1 cm in the whole liver. Question Can respiration triggering (TRIG) improve the detection of small FLL compared to FB diffusion-weighted imaging? Findings Among 885 segmented FLL, TRIG was superior to FB for lesions smaller than 8 mm and had improved CNR and visibility. Clinical relevance Diffusion-weighted magnetic resonance imaging is used for the detection of focal liver lesions and image quality is influenced by breathing motion. Navigator triggering becomes more important for smaller lesions, and seems recommendable for the detection of small focal liver lesions.