ArticleBMJ open quality2025
Overcoming breath-hold difficulties with GRASP VIBE for contrast-enhanced MRI liver and pancreas to improve image diagnostic quality.
Article in BMJ open quality, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Contrast-enhanced MRI is essential for the evaluation and characterisation of indeterminate liver and pancreatic lesions. Conventional volumetric 3D T1-weighted sequences, such as the volumetric interpolated breath-hold examination (VIBE), play a key role in dynamic contrast-enhanced imaging of these organs. However, these sequences typically require a sustained breath-hold of 18-22 s to achieve optimal image quality. This requirement poses significant challenges for elderly or critically ill patients, often leading to suboptimal images, reduced diagnostic image quality, scan cancellations or conversion to non-contrast studies.This quality improvement project at a radiology department in a tertiary care hospital spanned 18 months and employed two plan-do-study-act (PDSA) cycles. At baseline, the existing dynamic VIBE sequence was optimised to the shortest feasible breath-hold duration of 12-17 s. While this modification improved image quality for patients capable of brief breath-hold, it remained inadequate for those unable to comply with breath-hold instructions. Consequently, the golden-angle radial sparse parallel VIBE (GRASP VIBE) sequence was applied. This technique enabled free-breathing imaging and retrospective reconstruction of multiple contrast-enhanced phases, offering a viable solution for patients with limited or no breath-hold capacity. In the first PDSA cycle, a trial of GRASP VIBE on patients with breath-hold difficulties demonstrated its feasibility and improved diagnostic value, leading to its broader implementation over 6 months. The second PDSA cycle expanded GRASP VIBE usage to all patients with breath-hold limitations, including those requiring liver-specific contrast agents (gadoxetate disodium) that necessitate prolonged imaging times.The implementation yielded a 42% reduction in suboptimal images, 75% decrease in scan cancellations and 90% drop in omission of contrast media administration. GRASP VIBE improved diagnostic image quality, minimised breathing artefacts and increased departmental efficiency.This initiative demonstrates GRASP VIBE as an effective solution for breath-hold challenges encountered in MRI liver and pancreas scans.
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