Hepatic pseudo-anisotropy: a specific artifact in hepatic diffusion-weighted images obtained with respiratory triggering

Purpose: Hepatic pseudo-anisotropy is an artifact observed in hepatic diffusion-weighted imaging under respiratory triggering (RT-DWI). To determine the clinical significance of this phenomenon, hepatic RT-DW images were reviewed. Methods: One hundred and five MR examinations, including RT-DWI, were assessed. The patient group included 62 non-cirrhotic and 43 cirrhotic individuals. All images were evaluated by mutual agreement of two radiologists from the viewpoints of incidence of pseudo-anisotropy and correlation between pseudo-anisotropy and the quality of trace images. The ADC of normal hepatic parenchyma of non-cirrhotic livers were measured in both areas with and without pseudoanisotropy. Results: Pseudo-anisotropy was observed in 60% of non-cirrhotic (37/62) and 30% of cirrhotic (13/43) images. The difference between the two groups was statistically significant (P < 0.001). The quality of trace images showed a tendency to worsen as pseudo-anisotropy became significant. However, the quality of trace images was generally satisfactory, with only two patients whose trace images were difficult to interpret due to pseudo-anisotropy. The areas with pseudo-anisotropy showed higher ADC than those without pseudo-anisotropy (P < 0.001). Conclusion: Pseudo-anisotropy is a type of artifact that originates from respiratory movement. Even though respiratory triggering is employed, ADC measurement of the liver is inaccurate because of pseudo-anisotropy, especially in noncirrhoticpatients.