Routine MR imaging protocol with breath-hold fast scans: Diagnostic efficacy for focal liver lesions

Purpose: To qualitatively and quantitatively evaluate the diagnostic efficacy of the breathhold magnetic resonance (MR) imaging sequences in widespread clinical use for detection and characterization of focal hepatic lesions. Materials and Methods: Fifty patients with 143 lesions [57 hepatocellular carcinomas (HCC), 10 borderline lesions, 18 metastatic tumors, 21 hemangiomas, and 37 cysts] underwent single-shot fast spin echo (SSFSE), fast spin echo (FSE), and gadolinium-enhanced dynamic fast spoiled gradient-recalled acquisition in steady state (FSPGR) breath-hold MR imaging of the liver. Alternative free receiver operating characteristic (AFROC) analysis was performed to independently and prospectively assess each sequence. Results: For solid lesions, dynamic FSPGR allowed the most sensitive lesion detection and produced the highest lesion conspicuity and lesion-liver contrast-to-noise ratio (CNR). For non-solid benign lesions, SSFSE and FSE produced better results than dynamic FSPGR. SSFSE allowed the most sensitive detection and produced the best lesion conspicuity and lesion-liver CNR. Conclusion: SSFSE and dynamic FSPGR comprise the optimal imaging protocol for breathhold MR assessment of focal hepatic lesions. This combination of sequences allows acquisition of critical diagnostic information about both inherent T2 and T1 lesion contrast and lesion vascularity.