Clinical Evaluation of Respiratory-triggered 3D MRCP with Navigator Echoes Compared to Breath-hold Acquisition Using Compressed Sensing and/or Parallel Imaging

PURPOSE: To compare the image quality of three-dimensional magnetic resonance cholangiopancreatography (MRCP) acquired with respiratory triggering against breath-hold 3D MRCP with compressed sensing (CS) and parallel imaging (PI) in a clinical setting. METHODS: This study included 93 patients (45 men, mean age: 69.7 ± 9.3 years), in whom three types of 3D MRCP were performed: 3D breath-hold MRCP with CS and PI reconstruction (BH-CS-MRCP) and PI only reconstruction (BH-PI-MRCP) additionally to 3D respiratory triggered MRCP with navigator echoes (Nav-MRCP). Duct visualization and overall image quality were blindly evaluated on a four-point scale by two independent radiologists. Quantitative analysis was performed by calculating the relative duct-to-periductal contrast (RC) of three main biliary segments. Comparison between the methods was performed using paired t-test. RESULTS: Acquisition time was 23 s for both breath-hold MRCP protocols and 1 min 29 s for Nav-MRCP. Mean grading (Nav/CS/PI) for common bile duct (2.74/2.87/2.94), common hepatic duct (2.82/2.92/3.00), central right hepatic duct (2.75/2.85/2.98), central left hepatic duct (2.75/2.85/2.92) and cystic duct (2.22/2.34/2.42) was higher in BH-CS- and BH-PI-MRCP, whereas Nav-MRCP showed higher grading in the peripheral segments (peripheral right hepatic duct: 2.24/2.01/2.12; peripheral left hepatic duct: 2.23/2.02/2.13). Overall image quality of Nav-MRCP (2.91 ± 0.7) was not different from BH-PI-MRCP (2.92 ± 0.6) (P = 0.163), but higher than BH-CS-MRCP (2.80 ± 0.7) (P = 0.031). Quantitative analysis showed lower RC values for CS- and PI-MRCP than Nav-MRCP (P < 0.001). CONCLUSION: Breath-hold 3D MRCP were feasible using PI and CS. Visualization of the greater ductal system was even superior in breath-hold MRCP than in Nav-MRCP by considerably reducing acquisition time. Both breath-hold methods are suitable for revised MRI protocols notably in patients with irregular respiratory cycle.