Dual double arterial phase dynamic MR imaging with sensitivity encoding (SENSE): which is better for diagnosing hypervascular hepatocellular carcinomas, in-phase or opposed-phase imaging?

The purpose of this study was to investigate the efficacy of sensitivity encoding (SENSE) dynamic magnetic resonance imaging (MRI) with the dual (in-phase and opposed-phase) double arterial phase to detect hypervascular hepatocellular carcinomas (HCCs). MR images of the liver from 44 consecutive patients were obtained. Dynamic MRI with SENSE was performed six times (precontrast, early arterial, late arterial, 1 min, 3 min and 5 min after contrast injection) at 11 s per scan using the gradient recalled echo sequence (TR/TE/flip angle = 168/2.3 and 4.6/70). In-phase and opposed-phase images were obtained simultaneously each scan. For the quantitative analysis, the signal-to-noise ratio (S/N) of HCC and tumor-to-liver contrast-to-noise ratio (C/N) were analyzed for 55 HCCs. The mean S/N of HCCs on in-phase images showed significantly higher values than that on opposed-phase images regarding all phases (P < 0.001). In arterial phases, the mean tumor-to-liver C/N for in-phase images was significantly higher than that for opposed-phase images (P < 0.05). In portal and delayed-phase images, the mean tumor-to-liver C/N in opposed-phase images showed a negative value. In six HCCs with fatty metamorphosis, the mean tumor-to-liver C/N on arterial phase images approached zero in opposed-phase, while it showed a positive value in-phase. In dual double arterial phase dynamic MRI of the liver, in-phase images were superior to opposed-phase images for detecting early enhancement of hypervascular HCCs, while the latter were superior for detecting washout of contrast media from HCCs in the portal and delayed phase. The combination of both images overcomes the difficulty of diagnosing hypervascular HCCs with fatty metamorphosis.