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Free-Breathing Accelerated Whole-Body MRI Using Automated Workflow: Comparison to Conventional Breath-Hold Sequences.

BACKGROUND
Whole-body MRI becomes increasingly popular in oncology. However, the long acquisition time might hamper its widespread application. We sought to assess and compare free-breathing sequences with conventional breath-hold examinations in whole-body MRI using an automated workflow process.


METHODS
This prospective study consisted of 20 volunteers and 6 patients with a variety of pathologies who had undergone whole body 1.5-Tesla MRI that included T2- and T1-weighted radial and Dixon volumetric interpolated breath-hold examination (VIBE) sequences. Free-breathing sequences were operated by using an automated user interface. Image quality, diagnostic confidence, and image noise were evaluated by two experienced radiologists. Additionally, signal-to-noise ratio was measured. Diagnostic performance for the overall detection of pathologies was assessed using the area under the receiver operating characteristics curve (AUC). Study participants were asked to rate their examination experience in a satisfaction survey.


RESULTS
MR free-breathing scans were rated as at least equivalent to conventional MR scans in more than 92% of cases, showing high overall diagnostic accuracy (95% [95% CI 92-100]) and performance (AUC 0.971, 95% CI 0.942 to 0.988; P < 0.0001) for the assessment of pathologies at simultaneously reduced examination time (25 ± 2 vs. 32 ± 3 minutes; P < 0.0001). Interrater agreement was excellent for both, free-breathing (ϰ = 0.96 [95% CI, 0.88-1.00]) and conventional scans (ϰ = 0.93 [95% CI, 0.84-1.00]). Qualitative and quantitative assessment for image quality, image noise, and diagnostic confidence differed not significantly between the two types of MR image acquisition (all P > 0.05). Scores for patient satisfaction were significantly better for free-breathing compared to breath-hold examinations (P = 0.0145), including significant correlations for the grade of noise (r=0.79, P < 0.0001), tightness (r=0.71, P < 0.0001), and physical fatigue (r=0.52, P = 0.0065).


CONCLUSIONS
Free-breathing whole-body MRI with automated user interface yielded similar diagnostic performance at equivalent image quality and shorter acquisition times compared to conventional breath-hold sequences.