Overcoming breath-hold difficulties with GRASP VIBE for contrast-enhanced MRI liver and pancreas to improve image...

Contrast-enhanced MRI is essential for the evaluation and characterisation of indeterminate liver and pancreatic lesions. Conventional volumetric 3D T1-weighted sequences, such as the volumetric interpolated breath-hold examination (VIBE), play a key role in dynamic contrast-enhanced imaging of these organs. However, these sequences typically require a sustained breath-hold of 18-22 s to achieve optimal image quality. This requirement poses significant challenges for elderly or critically ill patients, often leading to suboptimal images, reduced diagnostic image quality, scan cancellations or conversion to non-contrast studies.This quality improvement project at a radiology department in a tertiary care hospital spanned 18 months and employed two plan-do-study-act (PDSA) cycles. At baseline, the existing dynamic VIBE sequence was optimised to the shortest feasible breath-hold duration of 12-17 s. While this modification improved image quality for patients capable of brief breath-hold, it remained inadequate for those unable to comply with breath-hold instructions. Consequently, the golden-angle radial sparse parallel VIBE (GRASP VIBE) sequence was applied. This technique enabled free-breathing imaging and retrospective reconstruction of multiple contrast-enhanced phases, offering a viable solution for patients with limited or no breath-hold capacity. In the first PDSA cycle, a trial of GRASP VIBE on patients with breath-hold difficulties demonstrated its feasibility and improved diagnostic value, leading to its broader implementation over 6 months. The second PDSA cycle expanded GRASP VIBE usage to all patients with breath-hold limitations, including those requiring liver-specific contrast agents (gadoxetate disodium) that necessitate prolonged imaging times.The implementation yielded a 42% reduction in suboptimal images, 75% decrease in scan cancellations and 90% drop in omission of contrast media administration. GRASP VIBE improved diagnostic image quality, minimised breathing artefacts and increased departmental efficiency.This initiative demonstrates GRASP VIBE as an effective solution for breath-hold challenges encountered in MRI liver and pancreas scans.