Respiratory motion artifacts during arterial phase imaging with gadoxetic acid: Can the injection protocol minimize this drawback?
To determine which of three gadoxetic acid injection techniques best reduced the contrast-related arterial-phase motion artifacts.



This Institutional Review Board (IRB)-approved, retrospective study included a cohort of 78 consecutive patients who each had serial gadoxetic acid-enhanced 3.0T magnetic resonance imaging (MRI) of the liver (0.025 mmol/kg body weight) performed with at least two of three injection techniques: M1 test bolus, undiluted, power-injected 1 mL/s; M2 test bolus, diluted 50% with saline, power-injected 1 mL/s; M3 fixed delay, undiluted, manually injected. Blinded to the injection method, three readers independently rated the randomized images for arterial-phase motion artifacts, arterial-phase timing, and arterial-phase lesion visibility using a four-point Likert scale.



Regarding respiratory artifacts, gadoxetic acid arterial-phase images were judged better with M3 (2.7 ± 0.7) and were significantly less than those with M1 (2.1 ± 1.1) (P = 0.0001). Arterial-phase M2 (2.50 ± 0.89) images were rated significantly better than arterial-phase M1 images (P = 0.012), but the difference between arterial-phase images with M3 and M2 scores was not statistically significant (P = 0.49). Arterial-phase timing was significantly better for M1 compared to M3, and for M2 compared to M3 (P < 0.0001 for both). The area under the curve was 0.59-0.68. However, there was no significant difference between M1 and M2 (P = 0.35). With regard to arterial-phase lesion visibility, there was no significant difference in the ratings between any of the three injection techniques (P = 0.29-0.72). Interreader agreement was moderate to substantial (κ = 0.41-0.62).



A diluted, power-injected protocol (M2) seems to provide good timing and minimize artifacts compared with two other injection methods. No significant difference was found in lesion visibility between these three methods.



3 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2017;46:1107-1114.
Department of Biomedical Imaging and Image-guided Therapy, Medical University, Vienna, Austria.
Stephan H
SH
Polanec
Department of Biomedical Imaging and Image-guided Therapy, Medical University, Vienna, Austria.
Hubert
H
Bickel
Department of Biomedical Imaging and Image-guided Therapy, Medical University, Vienna, Austria.
Pascal A T
PAT
Baltzer
Department of Biomedical Imaging and Image-guided Therapy, Medical University, Vienna, Austria.
Patrick
P
Thurner
Department of Biomedical Imaging and Image-guided Therapy, Medical University, Vienna, Austria.
Florian
F
Gittler
Department of Biomedical Imaging and Image-guided Therapy, Medical University, Vienna, Austria.
Jacqueline C
JC
Hodge
Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, North Carolina, USA.
Mustafa R
MR
Bashir
Department of Biomedical Imaging and Image-guided Therapy, Medical University, Vienna, Austria.
Ahmed
A
Ba-Ssalamah
D016477:Artifacts; D003287:Contrast Media / Q000008:administration & dosage*; D004064:Digestive System / Q000000981:diagnostic imaging*; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009038:Motion; D012119:Respiration; D012189:Retrospective Studies
D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA
MRI; artifacts; contrast-related artifacts; gadoxetic acid; liver; transient severe motion artifacts