Detection of hepatocellular carcinoma using double-echo FLASH sequence during the hepatic arterial phase

The purpose of this study was to compare the performance of in-phase and opposed-phase gradient-recalled echo (GRE) pulse sequences in paramagnetic contrast-enhanced magnetic resonance (MR) imaging of hepatocellular carcinomas (HCCs) during the hepatic arterial phase.

Thirty-four patients with 84 lesions with known or suspected HCCs, nine of whom had a fatty liver, were examined with double-echo GRE techniques under 1.5T before and 30 s after injection of gadopentenate dimeglumine at a dose of 0.1 mmol/kg. Echo times were 2.4 ms (opposed phase) and 5.0 ms (in phase). Contrast enhancement of the HCC detected in both in-phase and opposed-phase images was evaluated. The liver signal-to-noise ratio (SNR), lesion-liver contrast-to-noise ratio (CNR), and enhancement ratio (ER) were calculated for the largest lesion of each patient.

In dynamic gadolinium-enhanced images of the 84 HCCs, 81 (96.4%) were detected in both in-phase and opposed-phase images, two (2.4%) were detected in only in-phase images, and one (1.2%) was detected only in opposed-phase images. The liver SNR, CNR, and ER were 46.7+/-16.1, 15.2+/-10.3, and 0.637+/-0.268 for in-phase images, and 48.9+/-16.9, 16.3+/-11.8, and 0.647+/-0.309 for opposed-phase images, respectively. In patients with a fatty liver, the SNR, CNR, and ER were 46.0+/-18.1, 21.7+/-17.9, and 0.525+/-0.231 for in-phase images, and 44.3+/-18.7, 26.0+/-21.3, and 0.793+/-0.124 for opposed-phase images, respectively. No significant statistical differences were found between the in-phase and opposed-phase images.

Opposed-phase GRE imaging is equivalent to in-phase GRE sequences in patients with or without fatty liver for detection of HCC in dynamic gadolinium-enhanced images.