Preliminary Clinical Research On The Value Of MA-CDT-VIBE In The Detection Of The Hypervascular Hepatocirrhosis Nodules And Small Hepatocellular Carcinoma

PartⅠTHE CLINICAL FEASIBILITY RESEARCH OF MA-CDT-VIBE TECHNIQUE FOR DCE-MRI LIVER IMAGINGObjectiveTo evaluate the image quality and the feasibility of a CAIPIRINHA-Dixon-TWIST（CDT）-VIBE sequence in dynamic contrast enhanced MRI（DCE-MRI）of the liver compared with the use of a standard VIBE sequence.Materials and Methods1.The choice of subjects39 patients with the lesions of the liver who were referred to our institution between January 2015 and October 2015 were included in our study.There were 21males,18females,mean age 56±8.36 years old,range 28-79 years old.2.Apparatus and equipment1.5T super conducting magnetic resonance scanner（MAGNETOM Amira,Simens Healthcare Sector,Erlangen,Germany）was used to all the patients with liver lesions chose by us.Body coil is a 16 channel phased array.Sequences included the routine sequences and the DCE sequences.Routine MRI scanning was consisted of coronal T2 weighted imaging（T2WI）HASTE sequence,axial fat suppression T2WI,axial diffusion weighted imaging（DWI）sequence,axial in-phase and oppose-phase sequence and axial CD-VIBE sequence.The DCE MRI sequences included the axial arterial MA-CDT-VIBE（TE=2.39ms,TR=6.59ms,TA=20s,temporal resolution=2.8ms,the spatial resolution=0.8×0.8×3mm3）sequence,the axial portal venous CD-VIBE sequence,the axial delayed sequence,the coronal CD-VIBE sequence,the sagittal CD-VIBE sequence,the axial MA-CDT-VIBE sequence and the axial standard VIBE sequence.The FOV of all the sequences above try to cover all the parenchyma of the liver as much as possible.3.Data processing and measurementsAll data processing and measurement were performed directly on a workstation without extra post-processing.On the fifth sub-phase of the last MA-CDT-VIBE water-only images and the standard VIBE images,manually set circular region of interest（ROI）on the enhanced lesion region and normal parenchyma for the calculation of lesion to parenchyma signal ratio according the formula of lesion to parenchyma signal ratio=SI _lesion/SI _liver.The quality of the image comparison between the fifth sub-phase of the last MA-CDT-VIBE water-only images and the standard VIBE images were scored by two MRI diagnose residents who were blind to the image acquisition technique using the picture archiving and communication system（PACS）software to read the images and in consent based on a 5-point scale in term of the following parameters:movement artifacts;parallel acquisition technique（PAT）artifacts;liver edge sharpness;hepatic vessel clarity;lesion conspicuity;and overall image quality（include single sub-phase overall image quality and all five sub-phases overall image quality）.Before conducting the study examination,the readers agreed on the interpretations and scores for each of the evaluated parameters through the training sets.4.Statistical AnalysisSPSS 20.0 statistical analysis software package was used.All measurement data were indicated with`c±s.Single sample K-S test was used to test whether the lesion to parenchyma signal ratio was normally distributed.If it satisfied normal distribution,independent sample t-test was used to determine if the lesion to parenchyma signal ratio of the fifth sub-phase in the last CDT-VIBE water only images were significantly different from it of the standard VIBE images,otherwise,we will use the nonparametric test.The Wilcoxon Signed-Rank Test was used to investigate statistically significant differences in the qualitative scores of the two image sets recorded by the two readers.Values of P<0.05were considered statistically significant.Results1.The lesion to parenchyma signal ratio:The`c±s of the fifth sub-phase in the last CDT-VIBE water only images and the standard VIBE images were 0.897±1.643、0.874±1.964,especially.There were no significant difference in the lesion to parenchyma signal ratio between the CDT-VIBE water only images and the standard VIBE images.2.Image qualityWhen compared with the standard VIBE images,MA-CDT-VIBE had significantly severer PAT artifacts（P<0.01）and movement artifacts（P<0.01）.However,the lesion conspicuity liver,edge sharpness and hepatic vessel clarity on the MA-CDT-VIBE images were very close to them on standard VIBE images（P=0.013,P=0.821,0.091,respectively）;the single sub-phase overall image quality on the MA-CDT-VIBE images was lower than that of standard VIBE images（P=0.048）.But at the same time,the MA-CDT-VIBE images obtained higher scores than the standard VIBE images for all five sub-phases overall image quality.ConclusionIt is indicated from our study that despite apparent PAT artifacts,movement artifacts and a worse overall quality of the fifth sub-phase on the MA-CDT-VIBE images compared with the standard VIBE images,but the MA-CDT-VIBE images had an higher all five sub-phases overall image quality.The MA-CDT-VIBE sequence does acquire enough dynamic data in a short time with high spatial resolution.Part ⅡPRELIMINARY CLINICAL RESEARCH OF MA-CDT-VIBE IN THE DETECTION OF THE HYPERVASCULAR HEPATOCIRRHOSIC NODULES AND SMALL HEPATOCELLULAR CARCINOMAObjective The aim of this study is to assess the diagnostic performance of MA-CDT-VIBE sequence in detecting of the hypervascular hepatocirrhosis nodules and small hepatocellular carcinoma（s HCC）,so as to find a robust means for the clinic.Materials and Methods1.The choice of subjects34 consecutive patients with hepatocirrhosis diagnosed by Ultrasound during February 2015 to March 2015 underwent MRI in our institution.And there were 21 patients with 33 hypervascular hepatocirrhosic nodules and small hepatocellular carcinoma were included at last.There were 15 males,6 females,and mean age 61±5.79 years old,range41-79 years old.2.Apparatus and equipment1.5T super conducting magnetic resonance scanner（MAGNETOM Amira,Simens Healthcare Sector,Erlangen,Germany）was used to all the patients in our study.Body coil is a 16 channel phased array.Sequences included the routine sequences and the dynamic contrast enhanced（DCE）sequences.Routine MRI scanning was consisted of axial T2 WI HASTE sequence,axial fat suppression T2 WI,axial DWI,in-phase and oppose-phase sequence and a precontrast axial CD-VIBE sequence.The DCE MRI sequences included the axial arterial MA-CDT-VIBE sequence,the axial portal venous CD-VIBE sequence,the axial delayed sequence,the coronal CD-VIBE sequence,the sagittal CD-VIBE sequence.The FOV of all the sequences above try to cover all the parenchyma of the liver as much as possible.3.The definition of ESAP and the comparison between MA-CDT-VIBE and ESAPThere were five dynamic arterial sub-phases in MA-CDT-VIBE sequence with a temporal resolution of 2.8s and acquisition time of 20 s during one breath-hold,starting scanning 15 seconds after injection of GD-DTPA.The fourth of the 5 arterial acquisition sub-phases was considered the equivalent of a standard hepatic arterial phase [ESAP],that is to say,the ESAP scanned at the 23.4s after the start of contrast agent injection.The diagnostic results（lesion detection）judged in two independent consensus readings that were blinded to each others’ results in all 5 sub-phases were compared with the results in the single ESAP.The complete,comprehensive multi-sequence MRI examination was considered as the standard of reference for lesions detection.ResultsWith standard of the complete,comprehensive multi-sequence MRI examination,there were 33 lesions were detected in 21 patients.MA-CDT-VIBE showed an improved lesion detection rate compared with ESAP.（30/33 for the first and 33/33 for the second consensus reading,27/33 for the first and 29/33 for the second consensus reading,respectively）.What’s more,about the 73% of all the patients,the best arterial parenchyma contrast of one of the MA-CDT-VIBE was considered better than that of the ESAP.There was a high degree of interrater agreement between the 2 reading groups.（κ:0.68-0.91;P <0.001）ConclusionWhen it compared with a single standard hepatic arterial phase,MA-CDT-VIBE have a higher hypervascular hepatocirrhosis nodules and small hepatocellular carcinomca（s HCC）detection rate and provided a better and optimized hepatic arterial acquisition phase compared with the standard arterial phase.