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DOI: 10.1055/s-2008-1027279
© Georg Thieme Verlag KG Stuttgart · New York
Dynamische MRT der Leber mit paralleler Akquisitionstechnik: Charakterisierung fokaler Leberläsionen und Analyse des Gefäßstatus in einem Untersuchungsgang
Dynamic MRI of the Liver with Parallel Acquisition Technique: Characterization of Focal Liver Lesions and Analysis of the Hepatic Vasculature in a Single MRI SessionPublication History
eingereicht: 6.8.2007
angenommen: 15.2.2008
Publication Date:
25 April 2008 (online)

Zusammenfassung
Ziel: Das Ziel der Studie war es, eine schnelle, 3-dimensionale, Kontrastmittel-verstärkte dynamische Gradientenecho-Magnetresonanztomografie-Sequenz mit paralleler Akquisitionstechnik (pMRT) bezüglich Charakterisierung fokaler Leberläsionen (Goldstandard: histologischer Befund) sowie Analyse des Gefäßstatus (Goldstandard: 64-Zeilen-Computertomografie; MSCT) in einem Untersuchungsgang zu beurteilen. Material und Methode: Der pMRT-Datensatz von 45 Patienten (23 Männer, 22 Frauen; 28 - 77 Jahre, Durchschnitt 48 Jahre) mit insgesamt 68 Leberläsionen, die präoperativ mittels eines 1,5T-MRT abgeklärt wurden, wurde retrospektiv von 2 Radiologen unabhängig voneinander bezüglich Charakterisierung fokaler Leberläsionen sowie Bildqualität der Lebergefäße, Vorliegen hepatischer Gefäßvarianten, arterieller Stenosen und Pfortaderthrombosen analysiert. Die pMRT wurde mit folgenden Parametern durchgeführt: TR/TE/Matrix/Partitionsdicke/Akquisitionszeit: 3,1 ms/ 1,4 ms/ 384 × 224 / 4 mm/ 15 - 17 s. Die MSCT-Untersuchung erfolgte bei einem Pitch von 1,2, einer rekonstruierten Schichtdicke von 1 mm und einer Matrix von 512 × 512. Ergebnisse: Bei den 45 Patienten lagen 42 hepatozelluläre Karzinome (HCC), 20 Metastasen, 3 cholangiozelluläre Karzinome (CCC) sowie je 1 dysplastischer Knoten, 1 fokale noduläre Hyperplasie (FNH) und 1 atypisches Hämangiom vor. Es zeigte sich eine hohe diagnostische Genauigkeit von 91 - 100 % bei der Charakterisierung dieser Leberläsionen bei einer exzellenten Übereinstimmung der beiden Radiologen mit Kappawerten von 0,89 (Metastasen), 0,97 (HCC gesamt) und 1,0 (CCC). Im Durchschnitt wurde mit pMRT die Bildqualität aller untersuchten Gefäße in 89 % (Radiologe 1) bzw. 90 % (Radiologe 2) als gut oder exzellent bewertet. Varianten der Leberarterien, Lebervenen und der Portalvene sowie Pfortaderthrombosen konnten in der pMRT zuverlässig nachgewiesen werden. Arterielle Stenosen wurden mit einer Sensitivität zwischen 86 und 100 % beschrieben bei einer exzellenten Übereinstimung zwischen den Radiologen (κ = 0,85). Schlussfolgerungen: Die diagnostische Bildqualität der Leber bei Beschleunigung der Datenakquisition durch parallele Bildgebung bleibt in den meisten Fällen gut bis exzellent. Ebenso können fokale Leberläsionen und Pathologien bzw. Normvarianten des Gefäßstatus zuverlässig diagnostiziert werden. Die Einführung der pMRT in die Leberdiagnostik stellt einen weiteren Schritt in Richtung eines vereinfachten Abklärungsprotokolls von Patienten vor leberchirurgischen Eingriffen dar.
Abstract
Purpose: To retrospectively evaluate the performance of breath-hold contrast-enhanced 3D dynamic parallel gradient echo MRI (pMRT) for the characterization of focal liver lesions (standard of reference: histology) and for the analysis of hepatic vasculature (standard of reference: contrast-enhanced 64-detector row computed tomography; MSCT) in a single MRI session. Materials and Method: Two blinded readers independently analyzed preoperative pMRT data sets (1.5T-MRT) of 45 patients (23 men, 22 women; 28 - 77 years, average age, 48 years) with a total of 68 focal liver lesions with regard to image quality of hepatic arteries, portal and hepatic veins, presence of variant anatomy of the hepatic vasculature, as well as presence of portal vein thrombosis and hemodynamically significant arterial stenosis. In addition, both readers were asked to identify and characterize focal liver lesions. Imaging parameters of pMRT were: TR/TE/matrix/slice thickness/acquisition time: 3.1 ms/ 1.4 ms/ 384 × 224 / 4 mm/ 15 - 17 s. MSCT was performed with a pitch of 1.2, an effective slice thickness of 1 mm and a matrix of 512 × 512. Results: Based on histology, the 68 liver lesions were found to be 42 hepatocellular carcinomas (HCC), 20 metastases, 3 cholangiocellular carcinomas (CCC) as well as 1 dysplastic nodule, 1 focal nodular hyperplasia (FNH) and 1 atypical hemangioma. Overall, the diagnostic accuracy was high for both readers (91 - 100 %) in the characterization of these focal liver lesions with an excellent interobserver agreement (κ-values of 0.89 [metastases], 0.97 [HCC] and 1 [CCC]). On average, the image quality of all vessels under consideration was rated good or excellent in 89 % (reader 1) and 90 % (reader 2). Anatomical variants of the hepatic arteries, hepatic veins and portal vein as well as thrombosis of the portal vein were reliably detected by pMRT. Significant arterial stenosis was found with a sensitivity between 86 % and 100 % and an excellent interobserver agreement (κ = 0.85). Conclusions: Diagnostic image quality remains good or excellent in most cases when the data acquisition time is accelerated by means of parallel imaging in dynamic MRI. It allows reliable detection and characterization of focal liver lesions as well as the depiction of hepatic vascular variants, portal vein thrombosis, and arterial stenosis. Introducing pMRT in routine liver MRI may be another step towards a simplified diagnostic work-up prior to liver surgery.
Key words
abdomen - hepatic arteries - hepatic veins - CT - normal variants - MR imaging
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PD Dr. med. Jürgen K. Willmann
Department of Radiology, Stanford University
318 Campus Drive
94305 Stanford, USA
Phone: ++ 001/6 50/7 24 36 34
Fax: ++ 001/6 50/7 24 49 48
Email: willmann@stanford.edu