title: The Short Breath-Hold Technique, Controlled Aliasing in Parallel Imaging Results in Higher Acceleration, Can Be the First Step to Overcoming a Degraded Hepatic Arterial Phase in Liver Magnetic Resonance Imaging: A Prospective Randomized Control Study.
abstract: The aim of this study was to assess whether a short breath-hold technique can improve hepatic arterial phase (HAP) image quality in gadoxetic acid-enhanced magnetic resonance (MR) imaging compared with a conventional long breath-hold technique.
  
  
  
  Institutional review board approval and patient consent were obtained for this prospective randomized control study. One hundred nineteen patients undergoing gadoxetic acid-enhanced MR imaging were randomly assigned to groups A or B. Group A patients underwent an 18-second long breath-hold MR technique (conventional VIBE [volumetric interpolated breath-hold examination] technique with GRAPPA [generalized autocalibrating partially parallel acquisition]), and group B patients underwent a 13-second short breath-hold MR technique (VIBE technique with CAIPIRINHA [controlled aliasing in parallel imaging results in higher acceleration]). Respiratory-related graphs of the precontrast and HAP were acquired. The breath-hold degree was graded based on the standard deviation (SD) value of respiratory waveforms. Gadoxetic acid-related dyspnea was defined as when the SD value of the HAP was 200 greater than that of the precontrast phase without degraded image quality in the portal and transitional phases (SD value of the HAP - SD value of the precontrast phase). The overall image quality and motion artifacts of the precontrast and HAP images were evaluated. The groups were compared using the Student t or Fisher exact test, as appropriate.
  
  
  
  The incidence of breath-holding difficulty (breath-hold grades 3 and 4) during the HAP was 43.6% (27/62) and 36.8% (21/57) for group A and B, respectively. The SD value during the precontrast phase and the SD value difference between the precontrast and HAP were both significantly higher in group A than in group B (P = 0.047 and P = 0.023, respectively). Gadoxetic acid-related dyspnea was seen in 19.4% (12/62) of group A and 7.0% (4/57) of group B. Group B showed better precontrast and HAP image quality than group A (P < 0.001). Degraded HAP (overall image quality ≥4) was observed in 9.7% (6/62) and 3.5% (2/57) of group A and B, respectively.
  
  
  
  The short breath-hold MR technique, CAIPIRINHA, showed better HAP image quality with less degraded HAP and a lower incidence of breath-hold difficulty and gadoxetic acid-related dyspnea than the conventional long breath-hold technique.
authors.affiliation: From the Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea.
authors.forename: Jung Lim
authors.initials: JL
authors.lastname: Yoo
authors.forename: Chang Hee
authors.initials: CH
authors.lastname: Lee
authors.forename: Yang Shin
authors.initials: YS
authors.lastname: Park
authors.forename: Jeong Woo
authors.initials: JW
authors.lastname: Kim
authors.forename: Jongmee
authors.initials: J
authors.lastname: Lee
authors.forename: Kyeong Ah
authors.initials: KA
authors.lastname: Kim
authors.forename: Hae Young
authors.initials: HY
authors.lastname: Seol
authors.forename: Cheol Min
authors.initials: CM
authors.lastname: Park
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016477:Artifacts; D062485:Breath Holding; D003287:Contrast Media; D019786:Gadolinium DTPA; D006499:Hepatic Artery; D007089:Image Enhancement / Q000379:methods; D008099:Liver / Q000000981:diagnostic imaging; D008107:Liver Diseases / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging / Q000379:methods; D011446:Prospective Studies; D015203:Reproducibility of Results
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA; C073590:gadolinium ethoxybenzyl DTPA