Influence of dilution on arterial-phase artifacts and signal intensity on gadoxetic acid-enhanced liver MRI

To investigate the effect of saline-diluted gadoxetic acid, done for arterial-phase (AP) artifact reduction, on signal intensity (SI), and hence focal lesion conspicuity on MR imaging. We retrospectively examined 112 patients who each had at least two serial gadoxetic acid-enhanced liver MRIs performed at 1 ml/s, first with non-diluted (ND), then with 1:1 saline-diluted (D) contrast. Two blinded readers independently analyzed the artifacts and graded dynamic images using a 5-point scale. The absolute SI of liver parenchyma, focal liver lesions (if present), aorta, and portal vein at the level of the celiac trunk and the SI of the paraspinal muscle were measured in all phases. The signal-to-norm (SI${}_{Norm}$) of the vascular structures, hepatic parenchyma and focal lesions, and the contrast-to-norm (C${}_{Norm}$) of focal liver lesions were calculated. AP artifacts were significantly reduced with dilution. Mean absolute contrast-enhanced liver SI was significantly higher on the D exams compared to the ND exams. Likewise, SI${}_{Norm}$ of liver parenchyma was significantly higher in all contrast-enhanced phases except transitional phase on the D exams. SI${}_{Norm}$ values in the AP for the aorta and in the PVP for portal vein were significantly higher on the diluted exams. The C${}_{Norm}$ was not significantly different between ND and D exams for lesions in any imaging phase. The interclass correlation coefficient was excellent (0.89). Gadoxetic acid dilution injected at 1ml/s produces images with significantly fewer AP artifacts but no significant loss in SI${}_{Norm}$ or C${}_{Norm}$ compared to standard non-diluted images. Diluted gadoxetic acid at slow injection (1 ml/s) yielded images with higher SI${}_{Norm}$ of the liver parenchyma and preserved C${}_{Norm}$ for focal liver lesions. Gadoxetic acid-enhanced MRI injected at 1 ml/s is associated with arterial-phase (AP) artifacts in 31% of exams, which maydegrade image quality and limits focal liver lesion detection. Saline dilution of gadoxetic acid 1:1 combined with a slow injection rate of 1 ml/s significantly reduced AP artifacts from 31 to 9% and non-diagnostic AP artifacts from 16 to 1%.