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An Investigation of Transient Severe Motion Related to Gadoxetic Acid-enhanced MR Imaging
Utaroh Motosugi1, Peter Bannas1, Candice A Bookwalter1
1From the Departments of Radiology (U.M., P.B., C.A.B., S.B.R.), Medical Physics (S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology, University of Yamanashi, Yamanashi, Japan (U.M., K.S.); and Department of Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.B.).
Purpose:
To investigate the cause of imaging artifacts observed during gadoxetic acid-enhanced arterial phase imaging of the liver.
Materials And Methods:
This HIPAA-compliant study was approved by the institutional review board. Data were collected prospectively at two sites (site A, United States; site B, Japan) from patients undergoing contrast material-enhanced MR imaging with gadoxetic acid (site A, n = 154, dose = 0.05 mmol/kg; site B, n = 130, 0.025 mmol/kg) or gadobenate dimeglumine (only site A, n = 1666) from January 2014 to September 2014 at site A and from November 2014 to January 2015 at site B. Detailed comparisons between the two agents were made in the patients with dynamic liver acquisitions (n = 372) and age-, sex-, and baseline oxygen saturation (Spo2)-matched pairs (n = 130) at site A. Acquired data included self-reported dyspnea after contrast agent injection, Spo2, and breath-hold fidelity monitored with respiratory bellows.
Results:
Self-reported dyspnea was more frequent with gadoxetic acid than with gadobenate dimeglumine (site A, 6.5% [10 of 154] vs 0.1% [two of 1666], P < .001; site B, 1.5% [two of 130]). In the matched-pair comparison, gadoxetic acid, as compared with gadobenate dimeglumine, had higher breath-hold failure rates (site A, 34.6% [45 of 130] vs 11.7% [15 of 130], P < .0001; site B, 16.2% [21 of 130]) and more severe artifacts during arterial phase imaging (site A, 7.7% [10 of 130] vs 0% [none of 130], P < .001; site B, 2.3% [three of 130]). Severe imaging artifacts in patients who received gadoxetic acid were significantly associated with male sex (P = .023), body mass index (P = .021), and breath-hold failure (P < .001) but not with dyspnea or Spo2 decrease.
Conclusion:
Severe motion-related artifacts in the arterial phase of gadoxetic acid-enhanced liver MR imaging are associated with breath-hold failure but not with subjective feelings of dyspnea or a substantial decrease in blood Spo2. Subjective feelings of dyspnea are not necessarily associated with imaging artifacts. The phenomenon, albeit at a lower rate, was confirmed at a second site in Japan.
Insights
Gadoxetic acid-enhanced liver MRI shows artifacts linked to breath-hold failure, not patient-reported dyspnea. This study highlights breath-holding as a key factor in imaging quality for gadoxetic acid contrast agents.
Area of Science:
- Radiology
- Medical Imaging
- Contrast Agents
Background:
- Gadoxetic acid is a widely used liver MRI contrast agent.
- Imaging artifacts can compromise diagnostic accuracy.
- Understanding artifact causes is crucial for optimizing MRI protocols.
Purpose of the Study:
- To identify the cause of imaging artifacts during gadoxetic acid-enhanced arterial phase liver MRI.
- To compare artifact incidence between gadoxetic acid and gadobenate dimeglumine.
Main Methods:
- Prospective, multi-site study comparing gadoxetic acid and gadobenate dimeglumine.
- Data collected on patient-reported dyspnea, oxygen saturation (Spo2), and breath-hold fidelity.
- Matched-pair analysis to control for confounding factors.
Main Results:
- Gadoxetic acid use was associated with higher rates of dyspnea and breath-hold failure compared to gadobenate dimeglumine.
- Severe arterial phase imaging artifacts were significantly linked to breath-hold failure in gadoxetic acid studies.
- Dyspnea and Spo2 decrease were not significantly associated with severe artifacts.
Conclusions:
- Motion-related artifacts in gadoxetic acid-enhanced liver MRI are primarily associated with breath-hold failure.
- Subjective dyspnea does not reliably predict the presence or severity of imaging artifacts.
- Findings were validated across two international sites.
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