Detection of focal liver lesions in unenhanced and ferucarbotran-enhanced magnetic resonance imaging: a comparison of T2-weighted breath-hold and respiratory-triggered sequences Matthias Rief a , Moritz Wagner a , Tobias Franiel a , Viola Bresan b , Matthias Taupitz a , Christian Klessen a , Bernd Hamm a , Patrick Asbach a, ⁎ a Department of Radiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Campus Mitte, 10117 Berlin, Germany b Department of Cardiology, Rehabilitation Center of Cardiovascular Diseases, Klinik am See, Seebad 84, 15562 Rüdersdorf/Berlin, Germany Received 13 October 2008; revised 2 February 2009; accepted 6 May 2009 Abstract Purpose: To investigate the image quality and detection rate of focal liver lesions by comparing a T2-weighted breath-hold single-shot sequence and a T2-weighted high spatial resolution fast spin-echo sequence with respiratory triggering via unenhanced and superparamagnetic iron oxide (SPIO)-enhanced liver imaging. Materials and Methods: The study was approved by the local ethical review board; informed consent was waived. Liver-lesion contrast was measured and a qualitative consensus evaluation of image quality and lesion detection was performed in 42 consecutive patients using a 1.5- T MR system. Results: The liver-lesion contrast was significantly higher (Pb .05) for the respiratory-triggered sequence compared to the breath-hold sequence regarding unenhanced and SPIO-enhanced imaging. The respiratory-triggered sequences revealed significantly higher image quality scores as well as higher numbers of detected liver lesions compared to the breath-hold sequence on unenhanced and SPIO-enhanced imaging. The SPIO contrast did not significantly improve the number of detected lesions on the respective sequences (PN .05). Conclusion: We find that respiratory-triggered fast spin-echo sequences produce a higher image quality and a more precise liver-lesion detection rate thereby justifying the increased acquisition time necessary for this method. © 2009 Elsevier Inc. All rights reserved. Keywords: Liver imaging; Lesion detection; Respiratory triggering; SPIO 1. Introduction Precise assessment of focal liver lesions is mandatory for the management of cancer patients, as the exact number and location of malignant lesions impact therapeutic approaches, in particular, deciding between curative surgi- cal or palliative nonsurgical options [1–3]. Magnetic reso- nance imaging (MRI), especially T2-weighted sequences, plays a vital role in the detection of focal hepatic lesions; to this end, high spatial resolution and liver-lesion contrast are most favorable [4]. Even though previously, various technical improvements with regard to MRI hardware and software as well as multiple contrast media have been introduced, it is important to note that spatial resolution in liver imaging is limited by the breath-hold period. Respiratory triggering is an approach to extend the time frame beyond the breath-hold period thereby increasing spatial resolution [5]. The major drawback of respiratory triggering is the acquisition time required, which ranges in the order of several minutes. Ferucarbotran, a monocyte–macrophage system-directed superparamagnetic iron oxide (SPIO)-based contrast medium, can be used to ameliorate the detection of liver lesions on T2-weighted sequences acquired in the uptake phase approximately 10 min postinjection. Both T2-weighted breath-hold and respiratory- triggered sequences as well as T2⁎-weighted sequences are Available online at www.sciencedirect.com Magnetic Resonance Imaging 27 (2009) 1223 – 1229 ⁎ Corresponding author. Tel.: +49 30 450 627 417; fax: +49 30 450 527 911. E-mail address: patrick.asbach@charite.de (P. Asbach). 0730-725X/$ – see front matter © 2009 Elsevier Inc. All rights reserved. doi:10.1016/j.mri.2009.05.001