title: Navigated three-dimensional T1-weighted gradient-echo sequence for gadoxetic acid liver magnetic resonance imaging in patients with limited breath-holding capacity.
abstract: OBJECTIVE
  To determine whether a navigator-gated three-dimensional T1-weighted gradient-echo sequence (T1W-GRE, navigated LAVA) can improve diagnostic performance for the detection of focal liver lesions (FLLs) compared to standard breath-hold (BH) T1W-GRE breath-hold LAVA (BH-LAVA) during the hepatobiliary phase (HBP) of gadoxetic acid liver magnetic resonance imaging (MRI) in patients with limited breath-holding capacity.
  
  
  METHODS
  This retrospective study was approved by our institutional review board and the requirement for informed consent was waived. We included 372 patients who underwent liver MRI including both navigated LAVA and BH-LAVA sequences. Overall image quality of the two HBP image sets was compared. In patients with limited breath-holding capacity, diagnostic performances in detecting FLLs on the two HBP images were compared using jackknife-alternative free-response receiver-operating characteristic (JAFROC) analysis by two reviewers.
  
  
  RESULTS
  There were 13 cases (13/372; 3.5%) of image acquisition failure using the navigated LAVA sequence due to severe irregular breathing, and 50 of 359 patients had limited breath-holding capacity. In these patients, overall image quality of navigated LAVA (2.78 ± 0.95) was significantly better than that of BH-LAVA (2.42 ± 0.81, P < 0.005), and both readers showed significantly higher JAFROC figure-of-merit values with navigated LAVA compared to BH-LAVA (0.94 and 0.86 in reviewer 1, respectively; 0.89 and 0.83 in reviewer 2, respectively, P < 0.005). Overall image quality of navigated LAVA was also better than that of BH-LAVA in patients with sufficient breath-holding capacity (n = 309, 3.96 ± 0.88, 3.81 ± 0.66, respectively, P < 0.001).
  
  
  CONCLUSIONS
  The navigated LAVA sequence could provide better image quality and diagnostic performance in detecting FLLs than BH-LAVA in patients with limited breath-holding capacity during HBP of gadoxetic acid MRI.
authors.affiliation: Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
authors.forename: Jeong Hee
authors.initials: JH
authors.lastname: Yoon
authors.forename: Jeong Min
authors.initials: JM
authors.lastname: Lee
authors.forename: Eun Sun
authors.initials: ES
authors.lastname: Lee
authors.forename: Jeehyun
authors.initials: J
authors.lastname: Baek
authors.forename: Sangwoo
authors.initials: S
authors.lastname: Lee
authors.forename: Yuji
authors.initials: Y
authors.lastname: Iwadate
authors.forename: Joon Koo
authors.initials: JK
authors.lastname: Han
authors.forename: Byung Ihn
authors.initials: BI
authors.lastname: Choi
mesh_terms: D000368:Aged; D062485:Breath Holding; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008099:Liver / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA