Reducing respiratory artifacts in gadoxetic acid-enhanced magnetic resonance imaging via a patient-adapted breath-holding training strategy

Q: What problem does the study address in gadoxetic acid-enhanced liver MRI?

It targets respiratory artifacts in the arterial phase that arise from inadequate breath-holding strategy, which can degrade image quality and limit diagnostic performance.

Q: How were patients grouped for the breath-holding training and contrast injection protocols?

Patients were divided into four groups by combining gradual versus non- gradual breath-holding training with diluted versus undiluted contrast injection patterns.

Q: Which protocol performed best for reducing arterial phase respiratory artifacts?

The non- gradual breath-holding training combined with diluted gadoxetic acid (2 mL/s with 50% dilution) showed the smallest artifact scores and improved AP image quality.

Sep 30, 2026

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Gadoxetic acid-enhanced liver MRI suffers from arterial phase (AP) respiratory artifacts when breath-holding training is inadequate, leading to image quality degradation. A retrospective study assessed whether a non- gradual breath training protocol combined with contrast dilution reduces AP respiratory artifacts in the upper abdomen. One hundred twenty-six patients were allocated to four breath-holding and injection-pattern groups and evaluated by two blinded radiologists using semiquantitative scoring plus SNR/CNR metrics. The non- gradual plus diluted strategy produced the fewest artifacts and better AP image quality.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Background

Methods

Results

Conclusions

Introduction

Original Article Reducing respiratory artifacts in gadoxetic acid-enhanced magnetic resonance imaging via a patient-adapted breath-holding training strategy Liangrui Fang1,2^, Chunyun Chen1, Shuyao He1, Xiaoyue Zhou3, Mengxiao Liu3, Zhiwei Zhang2*, Jun Zhao1*^ 17T Magnetic Resonance Translational Medicine Research Center/Department of Radiology, The First Affiliated Hospital of Army Medical University, Chongqing, China; 2The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; 3MR Research Collaboration Team, Diagnostic Imaging, Siemens Healthineers China, Shanghai, China Contributions: (I) Conception and design: J Zhao, L Fang, Z Zhang; (II) Administrative support: J Zhao, L Fang, Z Zhang; (III) Provision of study materials or patients: J Zhao, L Fang, S He; (IV) Collection and assembly of data: L Fang, C Chen; (V) Data analysis and interpretation: L Fang, J Zhao; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. *These authors contributed equally to this work. Correspondence to: Jun Zhao, MSc. Associate Chief Technologist, 7T Magnetic Resonance Translational Medicine Research Center/Department of Radiology, The First Affiliated Hospital of Army Medical University, 30 Gaotanyan Street Shapingba District, Chongqing 400038, China. Email: [zhaojun@tmmu.edu.cn](zhaojun@tmmu.edu.cn). Background: In gadoxetic acid-enhanced liver magnetic resonance imaging (MRI), an inadequate breath-holding strategy is an independent risk factor for image quality degradation in single-phase arterial acquisition. Therefore, optimizing breath-holding training protocols is critical. This study aimed to assess the effectiveness of a nongradual breath training protocol combined with contrast dilution for reducing arterial phase (AP) respiratory artifacts in upper abdomen gadoxetic acid-enhanced MRI. Methods: In this retrospective study, we enrolled 126 patients (91 males; mean age 52.65±11.07 years) who underwent gadoxetic acid-enhanced upper abdomen MRI for the first and only time from May 2019 to February 2020. All patients were divided into four groups according to different breath-holding training strategies and contrast injection patterns (group 1: gradual strategy + diluted injection; group 2: nongradual strategy + diluted injection; group 3: gradual strategy + undiluted injection; group 4: nongradual strategy + undiluted injection) . Two radiologists evaluated AP images in a blinded manner using a 5-point scale. Semiquantitative scores, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) of the hepatic artery and portal vein to the liver parenchyma, and CNR of the hepatic artery to the portal vein were compared between the four groups via Mann-Whitney and Kruskal-Wallis tests. The differences in transient severe motion (TSM) incidence rates and respiratory artifact scores between the gradual and nongradual groups were calculated via the adjusted the Chi-squared test and the Mann-Whitney, respectively. Results: The results of the 5-point scale evaluation showed that respiratory artifacts significantly differed between groups (group 1: 2.56±1.16; group 2: 1.53±0.62; group 3: 2.12±1.08; group 4: 1.79±0.89; P=0.002): groups 2 and 4 had smaller artifacts, and group 2 had the fewest number of artifacts. However, no statistically significant differences were observed in the scores for the hepatic artery (P=0.177), portal vein (P=0.214), abdominal aorta (P=0.599), and liver parenchyma (P=0.243) or for the total score (P=0.235) . The groups significantly differed terms of portal vein SNR (P<0.001), liver parenchyma SNR (P=0.035), and the CNR of ^ ORCID: Liangrui Fang, 0009-0000-8923-9197; Zhao Jun, 0000-0001-8611-3150. © AME Publishing Company. Quant Imaging Med Surg 2026;16(1):33 | [https://dx.doi.org/10.21037/qims-2025-1225](https://dx.doi.org/10.21037/qims-2025-1225) Page 2 of 13 Fang et al. Optimized breathing training for reduced motion artifacts the

FAQs

What problem does the study address in gadoxetic acid-enhanced liver MRI?

It targets respiratory artifacts in the arterial phase that arise from inadequate breath-holding strategy, which can degrade image quality and limit diagnostic performance.

How were patients grouped for the breath-holding training and contrast injection protocols?

Patients were divided into four groups by combining gradual versus non- gradual breath-holding training with diluted versus undiluted contrast injection patterns.

Which protocol performed best for reducing arterial phase respiratory artifacts?

The non- gradual breath-holding training combined with diluted gadoxetic acid (2 mL/s with 50% dilution) showed the smallest artifact scores and improved AP image quality.

Sep 30, 2026

Uploaded by Terk