Single-shot T2-Weighted Turbo Spin-echo Imaging of the Liver Improves Lesion Characterization Compared with Free-breathing Acquisition.

Rationale

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Objectives

T2-weighted imaging is essential for liver magnetic resonance imaging (MRI), but conventional free-breathing turbo spin-echo (FB-TSE) is prolonged and motion-sensitive. Single-shot techniques offer motion robustness but compromise image quality. The aim is to evaluate whether single-shot turbo spin-echo (SS-TSE) provides superior lesion conspicuity and accurate Liver Imaging Reporting and Data System (LI-RADS) categorization compared with FB-TSE, and whether deep learning-based reconstruction (SS-TSE+DLR) preserves this benefit while improving image quality.

Materials And Methods

This prospective study enrolled 141 patients with chronic liver disease who underwent liver MRI with three T2-weighted sequences: FB-TSE (164 s), SS-TSE (13.5 s), and SS-TSE+DLR (13.5 s). Quantitative analysis assessed signal-to-noise ratio (SNR), signal homogeneity, and lesion-to-liver contrast-to-noise ratio (CNR) for 127 lesions ≥10 mm. Two radiologists independently evaluated qualitative image parameters and LI-RADS categories for 340 lesions ≥5 mm, including 213 hepatocellular carcinomas (HCCs), 104 cysts, and 23 hemangiomas.

Results

SS-TSE+DLR demonstrated significantly higher SNR, signal homogeneity, and CNR than both FB-TSE and SS-TSE (all p≤0.032). Qualitative scores for liver edge sharpness, vessel delineation, artifact suppression, and overall image quality favored SS-TSE+DLR (all p ≤ 0.046). Compared with FB-TSE, SS-TSE and SS-TSE+DLR significantly reduced false "favoring malignancy" assignments in benign lesions and "not identifiable" T2 features in HCC, facilitating significant upgrading from LR-3 to LR-4/5 (from 40.4%/41.8% to 67.1%/68.1%; p < 0.001) with significant overall LI-RADS categorization shift (p = 0.018).

Conclusion

SS-TSE, independent of DLR, improved T2-weighted ancillary feature assessment and LI-RADS categorization of HCC over FB-TSE via a 91.8% reduction in acquisition time; DLR did not alter these outcomes but improved image quality and lesion conspicuity.