Focal hepatic lesion detection: comparison of four T2-weighted MR imaging pulse sequences

To evaluate T2-weighted magnetic resonance (MR) imaging with conventional spin-echo, breath-hold fast spin-echo, respiratory-triggered fast spin-echo, and breath-hold multishot spin-echo echo-planar sequences for detection of focal hepatic lesions.

T2-weighted MR images obtained with the four sequences in 56 patients with 107 solid and 124 nonsolid lesions were retrospectively analyzed. Image review was conducted on a liver segment-by-segment basis; a total of 408 liver segments were reviewed separately and independently for solid and nonsolid lesions by three radiologists. Diagnostic accuracy was evaluated with receiver operating characteristic analysis.

Lesion-to-liver contrast-to-noise ratio was highest with multishot echo-planar images of both solid and nonsolid lesions. Diagnostic accuracy for solid lesions was statistically significantly better with conventional spin-echo images than with any other type of image (P < .0001). Diagnostic accuracy for nonsolid lesions was statistically significantly better with respiratory-triggered fast spin-echo images than with any other type of image (P < .0001). Image quality was best with breath-hold fast spin-echo images.

Conventional spin-echo MR imaging should not be replaced with breath-hold fast spin-echo or multishot spin-echo echo-planar imaging, despite the shorter acquisition times that are possible with the latter two sequences.