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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 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problem does the study address in gadoxetic acid-enhanced liver MRI?","Question",{"text":63,"@type":64},"It targets respiratory artifacts in the arterial phase that arise from inadequate breath-holding strategy, which can degrade image quality and limit diagnostic performance.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How were patients grouped for the breath-holding training and contrast injection protocols?",{"text":68,"@type":64},"Patients were divided into four groups by combining gradual versus non- gradual breath-holding training with diluted versus undiluted contrast injection patterns.",{"name":70,"@type":61,"acceptedAnswer":71},"Which protocol performed best for reducing arterial phase respiratory artifacts?",{"text":72,"@type":64},"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 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imaging via a patient-adapted breath-holding training strategy  \nLiangrui Fang1,2^, Chunyun Chen1, Shuyao He1, Xiaoyue Zhou3, Mengxiao Liu3, Zhiwei Zhang2*, Jun Zhao1*^  \n17T 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  \nContributions: (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.  \n*These authors contributed equally to this work.  \nCorrespondence 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).  \nBackground: 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  \narterial phase (AP) respiratory artifacts in upper abdomen gadoxetic acid-enhanced MRI.  \nMethods: 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.  \nSemiquantitative 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  \nwere calculated via the adjusted the Chi-squared test and the Mann-Whitney, respectively.  \nResults: 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):  \ngroups 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\u003C0.001), liver parenchyma SNR (P=0.035), and the CNR of  \n^ ORCID: Liangrui Fang, 0009-0000-8923-9197; Zhao Jun, 0000-0001-8611-3150.  \n© 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)  \nPage 2 of 13 Fang et al. Optimized breathing training for reduced motion artifacts  \nthe","cbCaiqBet9IIdgQt","https://ap.wps.com/l/cbCaiqBet9IIdgQt","pdf",1514721,13,"English","# Background\n# Methods\n# Results\n# Conclusions\n# Introduction","[{\"question\":\"What problem does the study address in gadoxetic acid-enhanced liver MRI?\",\"answer\":\"It targets respiratory artifacts in the arterial phase that arise from inadequate breath-holding strategy, which can degrade image quality and limit diagnostic performance.\"},{\"question\":\"How were patients grouped for the breath-holding training and contrast injection protocols?\",\"answer\":\"Patients were divided into four groups by combining gradual versus non- gradual breath-holding training with diluted versus undiluted contrast injection patterns.\"},{\"question\":\"Which protocol performed best for reducing arterial phase respiratory artifacts?\",\"answer\":\"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.\"}]","Reducing respiratory artifacts in gadoxetic acid-enhanced magnetic resonance imaging via a patient-adapted breath-holding training strategy | PDF",1790748825,33]