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Garcez DDC, Tepedino MS, Migueis DP, Vianna PM, Costacurta ASD, Portari EA, Messeder AMDC, Voegels RL, Boggi AC, Fujita RR, Thamboo A, Pezato R. A proposal for analyzing the inflammatory and remodeling processes of mucosa in chronic rhinosinusitis with nasal polyposis through MRI. Braz J Otorhinolaryngol 2024; 90:101490. [PMID: 39255692 DOI: 10.1016/j.bjorl.2024.101490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/23/2024] [Accepted: 07/24/2024] [Indexed: 09/12/2024] Open
Abstract
OBJECTIVES Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP) is a disease characterized by chronic inflammation and tissue remodeling process. The remodeling process in nasal polyps has mainly been studied by histology analysis. However, it is limited to a polyp fragment and requires tissue removal. The present study aims to evaluate the ability of Magnetic Resonance Imaging (MRI) to depict and characterize the remodeling process in patients with CRSwNP. METHODS 30 patients that met clinical diagnostic criteria for CRSwNP, without previous history of rhinosinusitis surgery were submitted to MRI scan (conventional, diffusion-weighted and DCE MRI) and compared with polyp tissue histological findings, IL-6 concentrations in the tissue and eosinophil count in the blood. The examinations were evaluated, independently, by two radiologists blinded to other radiological and histological data. The pathologist, blinded to MRI results, also compared the tissue sample from the most central and the most peripheral portion of the polypoid tissue adjacent to the floor of the nasal fossa. RESULTS This study demonstrated a characteristic pattern of nasal polyps, whose peripheral portions of nasal polypoid tissue are edematous, whereas the central portions in the middle meatus and in the middle and upper ethmoid are predominantly fibrotic. ADC values found in the most anterior portion of the polyps may be a marker for radiological phenotyping the remodeling process. This non-invasive analysis presented a high degree of agreement in the fibrosis and edema rating by two radiologists and the histological analysis was concordant with the MRI findings. The polyps were characterized as eosinophilic, and no relationship was found between the severity of the eosinophilic inflammatory process or concentration of IL-6 and the remodeling process. CONCLUSION MRI by using T2-weighted imaging sequence and ADCs values allows tissue characterization and is an effective tool for the differentiation of edematous and fibrotic components in CRSwNP. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Débora de Carvalho Garcez
- Universidade Federal de São Paulo, Departamento de Otorrinolaringologia-Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil; Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto, Rio de Janeiro, RJ, Brazil.
| | - Miguel Soares Tepedino
- Universidade do Estado do Rio de Janeiro, Divisão de Rinologia e Base do Crânio, Rio de Janeiro, RJ, Brazil
| | | | - Pedro Miño Vianna
- Universidade do Estado do Rio de Janeiro, Divisão de Rinologia e Base do Crânio, Rio de Janeiro, RJ, Brazil
| | | | - Elyzabeth Avvad Portari
- Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto, Rio de Janeiro, RJ, Brazil
| | | | - Richard Louis Voegels
- Universidade de São Paulo, Departamento de Oftalmologia e Otorrinolaringologia, São Paulo, SP, Brazil
| | - Alexandre Coelho Boggi
- Universidade Federal de São Paulo, Departamento de Otorrinolaringologia-Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Reginaldo Raimundo Fujita
- Universidade Federal de São Paulo, Departamento de Otorrinolaringologia-Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Andrew Thamboo
- University of British Columbia, Division of Rhinology, Vancouver, Canada
| | - Rogério Pezato
- Universidade Federal de São Paulo, Departamento de Otorrinolaringologia-Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil; University of British Columbia, Division of Rhinology, Vancouver, Canada
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Van AT, McTavish S, Peeters JM, Weiss K, Makowski MR, Braren RF, Karampinos DC. Motion-induced phase-corrected homodyne reconstruction for partial Fourier single-shot diffusion-weighted echo planar imaging of the liver. NMR IN BIOMEDICINE 2024; 37:e5147. [PMID: 38561247 DOI: 10.1002/nbm.5147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 04/04/2024]
Abstract
Partial Fourier encoding is popular in single-shot (ss) diffusion-weighted (DW) echo planar imaging (EPI) because it enables a shorter echo time (TE) and, hence, improves the signal-to-noise-ratio. Motion during diffusion encoding causes k-space shifting and dispersion, which compromises the quality of the homodyne reconstruction. This work provides a comprehensive understanding of the artifacts in homodyne reconstruction of partial Fourier ss-DW-EPI data in the presence of motion-induced phase and proposes the motion-induced phase-corrected homodyne (mpc-hdyne) reconstruction method to ameliorate these artifacts. Simulations with different types of motion-induced phase were performed to provide an understanding of the potential artifacts that occur in the homodyne reconstruction of partial Fourier ss-DW-EPI data. To correct for the artifacts, the mpc-hdyne reconstruction is proposed. The algorithm recenters k-space, updates the partial Fourier factor according to detected global k-space shifts, and removes low-resolution nonlinear phase before the conventional homodyne reconstruction. The mpc-hdyne reconstruction is tested on both simulation and in vivo data. Motion-induced phase can cause signal overestimation, worm artifacts, and signal loss in partial Fourier ss-DW-EPI data with the conventional homodyne reconstruction. Simulation and in vivo data showed that the proposed mpc-hdyne reconstruction ameliorated artifacts, yielding higher quality DW images compared with conventional homodyne reconstruction. Based on the understanding of the artifacts in homodyne reconstruction of partial Fourier ss-DW-EPI data, the mpc-hdyne reconstruction was proposed and showed superior performance compared with the conventional homodyne reconstruction on both simulation and in vivo data.
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Affiliation(s)
- Anh T Van
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Sean McTavish
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | | | | | - Marcus R Makowski
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Rickmer F Braren
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
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Bougia CΚ, Astrakas L, Pappa O, Maliakas V, Sofikitis N, Argyropoulou MI, Tsili AC. Diffusion tensor imaging and fiber tractography of the normal epididymis. Abdom Radiol (NY) 2024; 49:2932-2941. [PMID: 38836882 DOI: 10.1007/s00261-024-04372-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/30/2024] [Accepted: 05/03/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE To evaluate the feasibility of diffusion tensor imaging (DTI) and fiber tractography (FT) of the normal epididymis and to determine normative apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values. METHODS Twenty-eight healthy volunteers underwent MRI of the scrotum, including DTI on a 3.0 T system. For each anatomic part of the epididymis (head, body and tail) free-hand regions of interest were drawn and the mean ADC and FA were measured by two radiologists in consensus. Parametric statistical tests were used to determine intersubject differences in ADC and FA between the anatomic parts of each normal epididymis and between bilateral epididymides. Fiber tracts of the epididymis were reconstructed using the MR Diffusion tool. RESULTS The mean ADC and FA of the normal epididymis was 1.31 × 10-3 mm2/s and 0.20, respectively. No differences in ADC (p = 0.736) and FA (p = 0.628) between the anatomic parts of each normal epididymis were found. Differences (p = 0.020) were observed in FA of the body between the right and the left epididymis. FT showed the fiber tracts of the normal epididymis. Main study's limitations include the following: small number of participants with narrow age range, absence of histologic confirmation and lack of quantitative assessment of the FT reconstructions. CONCLUSION DTI and FT of the normal epididymis is feasible and allow the noninvasive assessment of the structural and geometric organization of the organ.
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Affiliation(s)
- Christina Κ Bougia
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece
| | - Loukas Astrakas
- Department of Medical Physics, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece
| | - Ourania Pappa
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece
| | - Vasileios Maliakas
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece
- Department of Clinical Radiology, University Hospital of Ioannina, St. Niarchos, 45500, Ioannina, Greece
| | - Nikolaos Sofikitis
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece
| | - Maria I Argyropoulou
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece
| | - Athina C Tsili
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece.
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Jiang YL, Li J, Zhang PF, Fan FX, Zou J, Yang P, Wang PF, Wang SY, Zhang J. Staging liver fibrosis with various diffusion-weighted magnetic resonance imaging models. World J Gastroenterol 2024; 30:1164-1176. [PMID: 38577177 PMCID: PMC10989501 DOI: 10.3748/wjg.v30.i9.1164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/15/2024] [Accepted: 02/07/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Diffusion-weighted imaging (DWI) has been developed to stage liver fibrosis. However, its diagnostic performance is inconsistent among studies. Therefore, it is worth studying the diagnostic value of various diffusion models for liver fibrosis in one cohort. AIM To evaluate the clinical potential of six diffusion-weighted models in liver fibrosis staging and compare their diagnostic performances. METHODS This prospective study enrolled 59 patients suspected of liver disease and scheduled for liver biopsy and 17 healthy participants. All participants underwent multi-b value DWI. The main DWI-derived parameters included Mono-apparent diffusion coefficient (ADC) from mono-exponential DWI, intravoxel incoherent motion model-derived true diffusion coefficient (IVIM-D), diffusion kurtosis imaging-derived apparent diffusivity (DKI-MD), stretched exponential model-derived distributed diffusion coefficient (SEM-DDC), fractional order calculus (FROC) model-derived diffusion coefficient (FROC-D) and FROC model-derived microstructural quantity (FROC-μ), and continuous-time random-walk (CTRW) model-derived anomalous diffusion coefficient (CTRW-D) and CTRW model-derived temporal diffusion heterogeneity index (CTRW-α). The correlations between DWI-derived parameters and fibrosis stages and the parameters' diagnostic efficacy in detecting significant fibrosis (SF) were assessed and compared. RESULTS CTRW-D (r = -0.356), CTRW-α (r = -0.297), DKI-MD (r = -0.297), FROC-D (r = -0.350), FROC-μ (r = -0.321), IVIM-D (r = -0.251), Mono-ADC (r = -0.362), and SEM-DDC (r = -0.263) were significantly correlated with fibrosis stages. The areas under the ROC curves (AUCs) of the combined index of the six models for distinguishing SF (0.697-0.747) were higher than each of the parameters alone (0.524-0.719). The DWI models' ability to detect SF was similar. The combined index of CTRW model parameters had the highest AUC (0.747). CONCLUSION The DWI models were similarly valuable in distinguishing SF in patients with liver disease. The combined index of CTRW parameters had the highest AUC.
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Affiliation(s)
- Yan-Li Jiang
- Department of Magnetic Resonance Imaging, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou 730030, Gansu Province, China
- Second Clinical School, Lanzhou University, Lanzhou 730030, Gansu Province, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou 730030, Gansu Province, China
| | - Juan Li
- Department of Hepatology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou 730030, Gansu Province, China
| | - Peng-Fei Zhang
- Department of Magnetic Resonance Imaging, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou 730030, Gansu Province, China
- Second Clinical School, Lanzhou University, Lanzhou 730030, Gansu Province, China
| | - Feng-Xian Fan
- Department of Magnetic Resonance Imaging, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou 730030, Gansu Province, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou 730030, Gansu Province, China
| | - Jie Zou
- Department of Magnetic Resonance Imaging, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou 730030, Gansu Province, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou 730030, Gansu Province, China
| | - Pin Yang
- Department of Magnetic Resonance Imaging, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou 730030, Gansu Province, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou 730030, Gansu Province, China
| | - Peng-Fei Wang
- Department of Magnetic Resonance Imaging, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou 730030, Gansu Province, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou 730030, Gansu Province, China
| | - Shao-Yu Wang
- MR Scientific Marketing, Siemens Healthineers, Xi’an 710065, Shaanxi Province, China
| | - Jing Zhang
- Department of Magnetic Resonance Imaging, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou 730030, Gansu Province, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou 730030, Gansu Province, China
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Tachikawa Y, Hamano H, Chiwata N, Yoshikai H, Ikeda K, Maki Y, Takahashi Y, Koike M. Diffusion weighted imaging combining respiratory triggering and navigator echo tracking in the upper abdomen. MAGMA (NEW YORK, N.Y.) 2024:10.1007/s10334-024-01150-1. [PMID: 38400926 DOI: 10.1007/s10334-024-01150-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVES To evaluate a new motion correction method, named RT + NV Track, for upper abdominal DWI that combines the respiratory triggering (RT) method using a respiration sensor and the Navigator Track (NV Track) method using navigator echoes. MATERIALS AND METHODS To evaluate image quality acquired upper abdominal DWI and ADC images with RT, NV, and RT + NV Track in 10 healthy volunteers and 35 patients, signal-to-noise efficiency (SNRefficiency) and the coefficient of variation (CV) of ADC values were measured. Five radiologists independently performed qualitative image-analysis assessments. RESULTS RT + NV Track showed significantly higher SNRefficiency than RT and NV (14.01 ± 4.86 vs 12.05 ± 4.65, 10.05 ± 3.18; p < 0.001, p < 0.001). RT + NV Track was superior to RT and equal or better quality than NV in CV and visual evaluation of ADC values (0.033 ± 0.018 vs 0.080 ± 0.042, 0.057 ± 0.034; p < 0.001, p < 0.001). RT + NV Track tends to acquire only expiratory data rather than NV, even in patients with relatively rapid breathing, and can correct for respiratory depth variations, a weakness of RT, thus minimizing image quality degradation. CONCLUSION The RT + NV Track method is an efficient imaging method that combines the advantages of both RT and NV methods in upper abdominal DWI, providing stably good images in a short scan time.
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Affiliation(s)
- Yoshihiko Tachikawa
- Division of Radiological Technology, Department of Medical Technology, Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga, 847-8588, Japan.
| | - Hiroshi Hamano
- Philips Japan, Philips Building, 2-13-37 Kohnan, Minato-ku, Tokyo, 108-8507, Japan
| | - Naoya Chiwata
- Division of Radiological Technology, Department of Medical Technology, Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga, 847-8588, Japan
| | - Hikaru Yoshikai
- Division of Radiological Technology, Department of Medical Technology, Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga, 847-8588, Japan
| | - Kento Ikeda
- Division of Radiological Technology, Department of Medical Technology, Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga, 847-8588, Japan
| | - Yasunori Maki
- Division of Radiological Technology, Department of Medical Technology, Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga, 847-8588, Japan
| | - Yukihiko Takahashi
- Department of Radiology, Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga, 847-8588, Japan
| | - Makiko Koike
- Department of Radiology, Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga, 847-8588, Japan
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Vasquez JA, Brown M, Woolsey M, Abdul-Ghani M, Katabathina V, Deng S, Blangero J, Clarke GD. Reproducibility and Repeatability of Intravoxel Incoherent Motion MRI Acquisition Methods in Liver. J Magn Reson Imaging 2024:10.1002/jmri.29249. [PMID: 38240167 PMCID: PMC11258206 DOI: 10.1002/jmri.29249] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Intravoxel incoherent motion (IVIM) diffusion weighted MRI (DWI) has potential for evaluating hepatic fibrosis but image acquisition technique influence on diffusion parameter estimation bears investigation. PURPOSE To minimize variability and maximize repeatably in abdominal DWI in terms of IVIM parameter estimates. STUDY TYPE Prospective test-retest and image quality comparison. SUBJECTS Healthy volunteers (3F/7M, 29.9 ± 12.9 years) and Family Study subjects (18F/12M, 51.7 ± 16.7 years), without and with liver steatosis. FIELD STRENGTH/SEQUENCE Abdominal single-shot echo-planar imaging (EPI) and simultaneous multi-slice (SMS) DWI sequences with respiratory triggering (RT), breath-holding (BH), and navigator echo (NE) at 3 Tesla. ASSESSMENT SMS-BH, EPI-NE, and SMS-RT data from twice-scanned healthy volunteers were analyzed using 6 × b-values (0-800 s⋅mm-2 ) and lower (LO) and higher (HI) b-value ranges. Family Study subjects were scanned using SMS and standard EPI sequences. The biexponential IVIM model was used to estimate fast-diffusion coefficient (Df ), fraction of fast diffusion (f), and slow-diffusion coefficient (Ds ). Scan time, estimated signal-to-noise ratio (eSNR), eSNR per acquisition, and distortion ratio were compared. STATISTICAL TESTS Coefficients of variation (CoV) and Bland Altman analyses were performed for test-retest repeatability. Interclass correlation coefficient (ICC) assessed interobserver agreement with P < 0.05 deemed significant. RESULTS Within-subject CoVs among volunteers (N = 10) for f and Ds were lowest in EPI-NE-LO (11.6%) and SMS-RT-HI (11.1%). Inter-observer ICCs for f and Ds were highest for EPI-NE-LO (0.63) and SMS-RT-LO (0.76). Df could not be estimated for most subjects. Estimated eSNR (EPI = 21.9, SMS = 4.7) and eSNR time (EPI = 6.7, SMS = 16.6) were greater for SMS, with less distortion in the liver region (DR-PE: EPI = 23.6, SMS = 13.1). DATA CONCLUSION Simultaneous multislice acquisitions had significantly less variability and higher ICCs of Ds , higher eSNR, less distortion, and reduced scan time compared to EPI. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Juan A. Vasquez
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Marissa Brown
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Mary Woolsey
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Mohammad Abdul-Ghani
- Diabetes Division, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Venkata Katabathina
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Shengwen Deng
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - John Blangero
- Department of Human Genetics, School of Medicine, The University of Texas Rio Grande Valley, Brownsville, TX, United States
| | - Geoffrey D. Clarke
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
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Jiang Y, Fan F, Zhang P, Wang J, Huang W, Zheng Y, Guo R, Wang S, Zhang J. Staging liver fibrosis by a continuous-time random-walk diffusion model. Magn Reson Imaging 2024; 105:100-107. [PMID: 37956960 DOI: 10.1016/j.mri.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/25/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Noninvasive assessment of liver fibrosis holds significant clinical importance. We aimed to evaluate the clinical potential of using a continuous-time random-walk diffusion model (CTRW) for staging liver fibrosis. METHODS This prospective study included 52 patients suspected of liver disease and scheduled for liver biopsy. All patients underwent multi-b value diffusion-weighted imaging (DWI) using a 1.5 T MR scanner to derive the anomalous diffusion coefficient (D) and temporal (α) and spatial (β) diffusion heterogeneity indexes sourced from the CTRW. The mono-exponential DWI-derived apparent diffusion coefficient (ADC), transient elastography-derived liver stiffness measurement (LSM), aspartate aminotransferase-to-platelet ratio index (APRI), and fibrosis-4 (FIB-4) index were calculated. We assessed and compared the correlations of these parameters with fibrosis stages and their efficacy in staging liver fibrosis. RESULTS Significant correlations with fibrosis stages were found for APRI (r = 0.336), FIB-4 (r = 0.351), LSM (r = 0.523), D (r = -0.458), and ADC (r = -0.473). Significant differences were observed between APRI, LSM, D, and ADC of different fibrosis stages. The diagnostic performance of an index that combined D, α, β, ADC, and LSM was superior to that of ADC or LSM alone for fibrosis stage F ≥ 2 and better than the index that combined D, α, β for fibrosis stage F ≥ 4. CONCLUSIONS Accurate liver fibrosis staging was achieved with a model that combined CTRW-derived parameters (D, α, and β), ADC, and LSM. The model could serve as a reliable tool for noninvasive fibrosis evaluation.
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Affiliation(s)
- Yanli Jiang
- Second Clinical School, Lanzhou University, Lanzhou, China; Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou, China
| | - Fengxian Fan
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou, China
| | - Pengfei Zhang
- Second Clinical School, Lanzhou University, Lanzhou, China; Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
| | - Jun Wang
- Second Clinical School, Lanzhou University, Lanzhou, China; Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
| | - Wenjing Huang
- Second Clinical School, Lanzhou University, Lanzhou, China; Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
| | - Yu Zheng
- Second Clinical School, Lanzhou University, Lanzhou, China; Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
| | - Ruiqing Guo
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou, China
| | - Shaoyu Wang
- MR Scientific Marketing, Siemens Healthineers, Shanghai, China
| | - Jing Zhang
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou, China.
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Grove RL, Vespa F, Aineseder M, Villamil A, Spina JC. Prognostic role of magnetic resonance imaging of the abdomen with intravenous contrast and magnetic resonance cholangiopancreatography in primary sclerosing cholangitis. Radiol Bras 2023; 56:301-307. [PMID: 38504819 PMCID: PMC10948161 DOI: 10.1590/0100-3984.2023.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/27/2023] [Accepted: 10/17/2023] [Indexed: 03/21/2024] Open
Abstract
Objective To evaluate the usefulness of Anali scores, determined by magnetic resonance imaging, for predicting the prognosis of primary sclerosing cholangitis (PSC) and to analyze interobserver variability, as well as to assess the impact of periportal edema and heterogeneous signal intensity on diffusion-weighted imaging of the liver. Materials and Methods This was a retrospective cohort study of 29 patients with PSC and baseline magnetic resonance imaging. Anali scores, without gadolinium (0-5 points) and with gadolinium (0-2 points), were calculated by two radiologists. Clinical end-points included liver transplantation, cirrhotic decompensation, and death. We calculated intraclass correlation coefficients (ICCs) for interobserver agreement on the Anali scores, performed Kaplan-Meier survival analysis comparing event-free survival among the score strata, and calculated the areas under receiver operating characteristic curves to determine sensitivity and specificity. Results Among the patients with a clinical event, the median Anali score was 4 (interquartile range [IQR], 2-5) without gadolinium and 2 (IQR, 1-2) with gadolinium, compared with 1 (IQR, 1.0-2.5) and 1 (IQR, 0.25-1.0), respectively, among those without a clinical event. The ICC was 0.79 (95% confidence interval: 0.57-0.91) for the Anali score with gadolinium and 0.99 (95% confidence interval: 0.98-0.99) for the Anali score without gadolinium. Periportal edema and heterogeneous signal intensity in the liver on diffusion-weighted imaging showed no statistical impact on clinical events (p = 0.65 and p = 0.5, respectively). Conclusion Anali scores correlate with clinical events in PSC, with a high level of interobserver agreement.
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Affiliation(s)
- Roy López Grove
- Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos
Aires, Argentina
| | - Florência Vespa
- Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos
Aires, Argentina
| | - Martina Aineseder
- Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos
Aires, Argentina
| | - Alejandra Villamil
- Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos
Aires, Argentina
| | - Juan Carlos Spina
- Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos
Aires, Argentina
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Omiya Y, Morisaka H, Matsuda M, Saito M, Hashimoto T, Motosugi U, Onishi H. Liver parenchymal changes detected by MR elastography and diffusion-weighted imaging after stereotactic body radiotherapy for hepatocellular carcinoma. Abdom Radiol (NY) 2023; 48:3353-3361. [PMID: 37542553 DOI: 10.1007/s00261-023-03995-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Stereotactic body radiotherapy (SBRT) is a local treatment option for hepatocellular carcinoma (HCC). SBRT-induced focal reactions on the liver parenchyma have not been thoroughly evaluated using quantitative magnetic resonance imaging (MRI). PURPOSE To quantitatively evaluate liver parenchymal changes caused by SBRT for HCC using magnetic resonance elastography (MRE) and diffusion-weighted imaging (DWI). METHOD We retrospectively evaluated 22 adult patients who received SBRT for HCC and 27 who received locoregional therapy other than SBRT (controls). Liver stiffness by MRE and apparent diffusion coefficient (ADC) values by DWI of the liver parenchyma were measured before and after SBRT. Regions of interest (ROIs) were drawn on the two areas of radiation dose distribution levels, > 30 Gy and ≤ 30 Gy; a ROI was drawn in the control group. The two indices were compared before and after SBRT using a Wilcoxon matched-pairs signed-rank test. RESULTS Liver stiffness and ADC values were significantly increased after SBRT in the dose areas of > 30 Gy compared with those before SBRT (4.05 vs 4.85 kPa; p < 0.05 in liver stiffness, and 1.10 vs 1.40 ×10-3 s/mm2; p < 0.05 in ADC values). In the dose area of ≦ 30 Gy, liver stiffness showed a significant increase in one reader (p = 0.033) but not in another reader (p = 0.085); ADC value showed no significant difference before and after SBRT as per both readers (p > 0.05). The control group demonstrated no significant differences before and after treatment (p > 0.05). CONCLUSION MRE and DWI can be used to detect SBRT-induced liver parenchymal changes.
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Affiliation(s)
- Yoshie Omiya
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan.
| | - Hiroyuki Morisaka
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Masaki Matsuda
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Masahide Saito
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Takaaki Hashimoto
- Department of Radiology, Kofu Municipal Hospital, Masutsubocho, Kofu, 400-0832, Japan
| | - Utaroh Motosugi
- Department of Radiology, Kofu-Kyoritsu Hospital, Takara, Kofu, Yamanashi, 400-0034, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
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Tsujita Y, Sofue K, Ueshima E, Ueno Y, Hori M, Murakami T. Clinical Application of Quantitative MR Imaging in Nonalcoholic Fatty Liver Disease. Magn Reson Med Sci 2023; 22:435-445. [PMID: 35584952 PMCID: PMC10552668 DOI: 10.2463/mrms.rev.2021-0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/23/2022] [Indexed: 11/09/2022] Open
Abstract
Viral hepatitis was previously the most common cause of chronic liver disease. However, in recent years, nonalcoholic fatty liver disease (NAFLD) cases have been increasing, especially in developed countries. NAFLD is histologically characterized by fat, fibrosis, and inflammation in the liver, eventually leading to cirrhosis and hepatocellular carcinoma. Although biopsy is the gold standard for the assessment of the liver parenchyma, quantitative evaluation methods, such as ultrasound, CT, and MRI, have been reported to have good diagnostic performances. The quantification of liver fat, fibrosis, and inflammation is expected to be clinically useful in terms of the prognosis, early intervention, and treatment response for the management of NAFLD. The aim of this review was to discuss the basics and prospects of MRI-based tissue quantifications of the liver, mainly focusing on proton density fat fraction for the quantification of fat deposition, MR elastography for the quantification of fibrosis, and multifrequency MR elastography for the evaluation of inflammation.
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Affiliation(s)
- Yushi Tsujita
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Keitaro Sofue
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Eisuke Ueshima
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yoshiko Ueno
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Masatoshi Hori
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takamichi Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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11
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Liu M, Zhang C, Shen S, Shao J, Wang Y, Jiao S, Guo C. Magnetic Resonance Diffusion Tensor Imaging Characterize the Hepatic Ischemia-Reperfusion Injury in an Animal Study. Transplant Proc 2023; 55:1739-1746. [PMID: 37393167 DOI: 10.1016/j.transproceed.2023.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Hepatic ischemia-reperfusion (I/R) injury is the main cause of morbidity and mortality after hepatectomy; thus, new methods for reducing I/R injury are required. The aim of this study is to evaluate changes in the average apparent diffusion coefficient (ADCavg) and fractional anisotropy (FA) in rabbits with partial hepatic I/R injury with magnetic resonance diffusion tensor imaging (DTI). METHODS The left lobe of the rabbit liver underwent 60 minutes of ischemia followed by 0.5, 2, 6, 12, 24, and 48 hours of reperfusion. T2-weighted images (T2WI), T1-weighted images (T1WI), DTI, and contrast-enhanced T1WI were performed; 6 b values were used for DTI on 6 diffusion directions. The serum levels of transaminases and liver histopathology findings were examined. RESULTS In the early stage of I/R (0.5 hour), ADCavg decreased significantly and increased sharply to 2 hours, then increased from 6 hours to 48 hours of reperfusion, except for a transient decrease (24 hours). Meanwhile, FA showed almost the opposite trend, drastically increasing during the first 0.5 hour and then slightly decreasing until 48 hours of reperfusion, except for an obvious decrease in the 2-hours group. The serum levels of liver markers and the pathologic scores were sharply increased in the I/R group after reperfusion and correlated with DTI of hepatic tissue after I/R. CONCLUSIONS Diffusion tensor imaging is feasible for imaging I/R-induced liver damage and can discriminate isotropic properties of the liver after I/R injury with objective changes in the ADCavg and FA. Diffusion tensor imaging can be a promising novel approach for use in clinical management after liver surgery.
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Affiliation(s)
- Minglu Liu
- Department of Medical Oncology, the First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China; Outpatient Department, Jingnan Medical Area, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Cheng Zhang
- Outpatient Department, Jingnan Medical Area, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Sandi Shen
- Thoracic Surgery, the Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, China
| | - Jiakang Shao
- Medical School of Chinese People's Liberation Army, Beijing, China
| | - Ying Wang
- Outpatient Department, Jingnan Medical Area, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Shunchang Jiao
- Department of Medical Oncology, the First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China.
| | - Chengwei Guo
- Department of Radiology, 82 Group Hospital of Chinese People's Liberation Army, Baoding, China.
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12
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Jang W, Jo S, Song JS, Hwang HP, Kim SH. Correction to: Comparison of diffusion‑weighted imaging and MR elastography in staging liver fibrosis: a meta‑analysis. Abdom Radiol (NY) 2023; 48:2763-2768. [PMID: 37231220 DOI: 10.1007/s00261-023-03942-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Weon Jang
- Department of Radiology, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea
- Biomedical Research Institute of Jeonbuk National University Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, Jeonbuk, 54907, Korea
| | - Seongil Jo
- Department of Statistics, Inha University, Incheon, Korea
| | - Ji Soo Song
- Department of Radiology, Jeonbuk National University Medical School and Hospital, Jeonju, Korea.
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea.
- Biomedical Research Institute of Jeonbuk National University Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, Jeonbuk, 54907, Korea.
| | - Hong Pil Hwang
- Department of Surgery, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Seong-Hun Kim
- Department of Internal Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
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13
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Zheng S, He K, Zhang L, Li M, Zhang H, Gao P. Conventional and artificial intelligence-based computed tomography and magnetic resonance imaging quantitative techniques for non-invasive liver fibrosis staging. Eur J Radiol 2023; 165:110912. [PMID: 37290363 DOI: 10.1016/j.ejrad.2023.110912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023]
Abstract
Chronic liver disease (CLD) ultimately develops into liver fibrosis and cirrhosis and is a major public health problem globally. The assessment of liver fibrosis is important for patients with CLD for prognostication, treatment decisions, and surveillance. Liver biopsies are traditionally performed to determine the stage of liver fibrosis. However, the risks of complications and technical limitations restrict their application to screening and sequential monitoring in clinical practice. CT and MRI are essential for evaluating cirrhosis-associated complications in patients with CLD, and several non-invasive methods based on them have been proposed. Artificial intelligence (AI) techniques have also been applied to stage liver fibrosis. This review aimed to explore the values of conventional and AI-based CT and MRI quantitative techniques for non-invasive liver fibrosis staging and summarized their diagnostic performance, advantages, and limitations.
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Affiliation(s)
- Shuang Zheng
- Department of Radiology, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, Jilin, China.
| | - Kan He
- Department of Radiology, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, Jilin, China.
| | - Lei Zhang
- Department of Radiology, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, Jilin, China.
| | - Mingyang Li
- Department of Radiology, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, Jilin, China.
| | - Huimao Zhang
- Department of Radiology, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, Jilin, China.
| | - Pujun Gao
- Department of Hepatology, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, Jilin, China.
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14
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Fritz V, Martirosian P, Machann J, Thorwarth D, Schick F. Soy lecithin: A beneficial substance for adjusting the ADC in aqueous solutions to the values of biological tissues. Magn Reson Med 2023; 89:1674-1683. [PMID: 36458695 DOI: 10.1002/mrm.29543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/31/2022] [Accepted: 11/11/2022] [Indexed: 12/04/2022]
Abstract
PURPOSE To test soy lecithin as a substance added to water for the construction of MRI phantoms with tissue-like diffusion coefficients. The performance of soy lecithin was assessed for the useable range of adjustable ADC values, the degree of non-Gaussian diffusion, simultaneous effects on relaxation times, and spectral signal properties. METHODS Aqueous soy lecithin solutions of different concentrations (0%, 0.5%, 1%, 2%, 3% …, 10%) and soy lecithin-agar gels were prepared and examined on a 3 Tesla clinical scanner at 18.5° ± 0.5°C. Echoplanar sequences (b values: 0-1000/3000 s/mm2 ) were applied for ADC measurements. Quantitative relaxometry and MRS were performed for assessment of T1 , T2 , and detectable spectral components. RESULTS The presence of soy lecithin significantly restricts the diffusion of water molecules and mimics the nearly Gaussian nature of diffusion observed in tissue (for b values <1000 s/mm2 ). ADC values ranged from 2.02 × 10-3 mm2 /s to 0.48 × 10-3 mm2 /s and cover the entire physiological range reported on biological tissue. Measured T1 /T2 values of pure lecithin solutions varied from 2685/2013 to 668/133 ms with increasing concentration. No characteristic signals of soy lecithin were observed in the MR spectrum. The addition of agar to the soy lecithin solutions allowed T2 values to be well adjusted to typical values found in parenchymal tissue without affecting the soy lecithin-controlled ADC value. CONCLUSION Soy lecithin is a promising substance for the construction of diffusion phantoms with tissue-like ADC values. It provides several advantages over previously proposed substances, in particular a wide range of adjustable ADC values, the lack of additional 1 H-signals, and the possibility to adjust ADC and T2 values (by adding agar) almost independently of each other.
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Affiliation(s)
- Victor Fritz
- Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Petros Martirosian
- Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Jürgen Machann
- Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Daniela Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, University of Tübingen, Tübingen, Germany
| | - Fritz Schick
- Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany.,Cluster of Excellence iFIT (EXC 2180) "Image Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
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15
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Obara M, Kwon J, Yoneyama M, Ueda Y, Cauteren MV. Technical Advancements in Abdominal Diffusion-weighted Imaging. Magn Reson Med Sci 2023; 22:191-208. [PMID: 36928124 PMCID: PMC10086402 DOI: 10.2463/mrms.rev.2022-0107] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Since its first observation in the 18th century, the diffusion phenomenon has been actively studied by many researchers. Diffusion-weighted imaging (DWI) is a technique to probe the diffusion of water molecules and create a MR image with contrast based on the local diffusion properties. The DWI pixel intensity is modulated by the hindrance the diffusing water molecules experience. This hindrance is caused by structures in the tissue and reflects the state of the tissue. This characteristic makes DWI a unique and effective tool to gain more insight into the tissue's pathophysiological condition. In the past decades, DWI has made dramatic technical progress, leading to greater acceptance in clinical practice. In the abdominal region, however, acquiring DWI with good quality is challenging because of several reasons, such as large imaging volume, respiratory and other types of motion, and difficulty in achieving homogeneous fat suppression. In this review, we discuss technical advancements from the past decades that help mitigate these problems common in abdominal imaging. We describe the use of scan acceleration techniques such as parallel imaging and compressed sensing to reduce image distortion in echo planar imaging. Then we compare techniques developed to mitigate issues due to respiratory motion, such as free-breathing, respiratory-triggering, and navigator-based approaches. Commonly used fat suppression techniques are also introduced, and their effectiveness is discussed. Additionally, the influence of the abovementioned techniques on image quality is demonstrated. Finally, we discuss the current and future clinical applications of abdominal DWI, such as whole-body DWI, simultaneous multiple-slice excitation, intravoxel incoherent motion, and the use of artificial intelligence. Abdominal DWI has the potential to develop further in the future, thanks to scan acceleration and image quality improvement driven by technological advancements. The accumulation of clinical proof will further drive clinical acceptance.
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Affiliation(s)
| | | | | | - Yu Ueda
- MR Clinical Science, Philips Japan Ltd
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16
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Tadimalla S, Wang W, Haworth A. Role of Functional MRI in Liver SBRT: Current Use and Future Directions. Cancers (Basel) 2022; 14:cancers14235860. [PMID: 36497342 PMCID: PMC9739660 DOI: 10.3390/cancers14235860] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/30/2022] Open
Abstract
Stereotactic body radiation therapy (SBRT) is an emerging treatment for liver cancers whereby large doses of radiation can be delivered precisely to target lesions in 3-5 fractions. The target dose is limited by the dose that can be safely delivered to the non-tumour liver, which depends on the baseline liver functional reserve. Current liver SBRT guidelines assume uniform liver function in the non-tumour liver. However, the assumption of uniform liver function is false in liver disease due to the presence of cirrhosis, damage due to previous chemo- or ablative therapies or irradiation, and fatty liver disease. Anatomical information from magnetic resonance imaging (MRI) is increasingly being used for SBRT planning. While its current use is limited to the identification of target location and size, functional MRI techniques also offer the ability to quantify and spatially map liver tissue microstructure and function. This review summarises and discusses the advantages offered by functional MRI methods for SBRT treatment planning and the potential for adaptive SBRT workflows.
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Affiliation(s)
- Sirisha Tadimalla
- Institute of Medical Physics, School of Physics, Faculty of Science, The University of Sydney, Camperdown, NSW 2006, Australia
- Correspondence:
| | - Wei Wang
- Crown Princess Mary Cancer Centre, Sydney West Radiation Oncology Network, Western Sydney Local Health District, Sydney, NSW 2145, Australia
| | - Annette Haworth
- Institute of Medical Physics, School of Physics, Faculty of Science, The University of Sydney, Camperdown, NSW 2006, Australia
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17
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Sheng R, Zhang Y, Sun W, Ji Y, Zeng M, Yao X, Dai Y. Staging Chronic Hepatitis B Related Liver Fibrosis with a Fractional Order Calculus Diffusion Model. Acad Radiol 2022; 29:951-963. [PMID: 34429260 DOI: 10.1016/j.acra.2021.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 12/17/2022]
Abstract
RATIONALE AND OBJECTIVES Accurately staging liver fibrosis is of great clinical significance. We aimed to evaluate the clinical potential of the non-Gaussian fractional order calculus (FROC) diffusion model in staging liver fibrosis. MATERIALS AND METHODS A total of 82 patients with chronic hepatitis B (CHB) were included in this prospective study. Diffusion weighted imaging (DWI)-derived parameters including the diffusion coefficient (D), fractional order parameter (β) and microstructural quantity (μ) sourced from FROC-DWI, and apparent diffusion coefficient (ADC) derived from mono-exponential DWI, as well as the aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis-4 (FIB-4) were calculated. Their correlations with fibrosis stages and the diagnostic efficacy in predicting liver fibrosis were assessed and compared. RESULTS D (r = -0.667), β (r = -0.671), μ (r = -0.481), and ADC (r = -0.665) displayed significant correlations with fibrosis stages (p < 0.001). D, β and ADC (p < 0.01) were independently associated with fibrosis; and compared to inflammatory activity, fibrosis was the independent factor significantly correlated with D, β and ADC (p < 0.001). There were no significant differences between the area under curves of D, β, μ or their combinations and ADC for predicting different fibrosis stages (p > 0.05). The diagnostic performance of the combined index with four diffusion metrics was better than D, β, μ or ADC used alone (p < 0.05) as well as APRI or FIB-4 (p < 0.01) in fibrosis staging. CONCLUSION FROC-DWI was valuable in staging liver fibrosis in patients with CHB, but there were no significant differences between the FROC-DWI parameters and the classical ADC. However, the combined DWI-derived index including D, β, μ and ADC offered the best diagnostic efficacy and may serve as a reliable tool for fibrosis evaluation, superior to APRI and FIB-4.
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Affiliation(s)
- Ruofan Sheng
- Department of Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai, China
| | - Yunfei Zhang
- Central Research Institute, United Imaging Healthcare, Shanghai, China
| | - Wei Sun
- Department of Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai, China
| | - Yuan Ji
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai, China.
| | - Xiuzhong Yao
- Department of Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai, China
| | - Yongming Dai
- Central Research Institute, United Imaging Healthcare, Shanghai, China
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ZENGİN FISTIKÇIOĞLU N, İNAN GÜRCAN N, TOSUN M, USLU H. Comparison of the Efficiency of Conventional Diffusion, Diffusion Tensor Imaging, and Dynamic Susceptibility Contrast-Enhanced Magnetic Resonance Perfusion Imaging in the Evaluation of Liver Fibrosis. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2021. [DOI: 10.30934/kusbed.936876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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19
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Hernando D, Zhang Y, Pirasteh A. Quantitative diffusion MRI of the abdomen and pelvis. Med Phys 2021; 49:2774-2793. [PMID: 34554579 DOI: 10.1002/mp.15246] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/05/2021] [Accepted: 09/15/2021] [Indexed: 12/14/2022] Open
Abstract
Diffusion MRI has enormous potential and utility in the evaluation of various abdominal and pelvic disease processes including cancer and noncancer imaging of the liver, prostate, and other organs. Quantitative diffusion MRI is based on acquisitions with multiple diffusion encodings followed by quantitative mapping of diffusion parameters that are sensitive to tissue microstructure. Compared to qualitative diffusion-weighted MRI, quantitative diffusion MRI can improve standardization of tissue characterization as needed for disease detection, staging, and treatment monitoring. However, similar to many other quantitative MRI methods, diffusion MRI faces multiple challenges including acquisition artifacts, signal modeling limitations, and biological variability. In abdominal and pelvic diffusion MRI, technical acquisition challenges include physiologic motion (respiratory, peristaltic, and pulsatile), image distortions, and low signal-to-noise ratio. If unaddressed, these challenges lead to poor technical performance (bias and precision) and clinical outcomes of quantitative diffusion MRI. Emerging and novel technical developments seek to address these challenges and may enable reliable quantitative diffusion MRI of the abdomen and pelvis. Through systematic validation in phantoms, volunteers, and patients, including multicenter studies to assess reproducibility, these emerging techniques may finally demonstrate the potential of quantitative diffusion MRI for abdominal and pelvic imaging applications.
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Affiliation(s)
- Diego Hernando
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Yuxin Zhang
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ali Pirasteh
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
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20
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Comparison of diffusion-weighted imaging and MR elastography in staging liver fibrosis: a meta-analysis. Abdom Radiol (NY) 2021; 46:3889-3907. [PMID: 33770223 DOI: 10.1007/s00261-021-03055-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/02/2021] [Accepted: 03/09/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare the diagnostic performance of diffusion-weighted imaging (DWI), gradient-recalled echo-based magnetic resonance elastography (GRE-MRE), and spin-echo echo-planar imaging-based MRE (SE-EPI-MRE) in liver fibrosis staging. METHODS A systematic literature search was done to collect studies on the performance of DWI, GRE-MRE, and SE-EPI-MRE for diagnosing liver fibrosis. Pooled sensitivity, specificity, diagnostic odds ratio, positive and negative likelihood ratio, and a summary receiver operating characteristic (ROC) curve were estimated with a bivariate random effects model. Subgroup analyses on various study characteristics were performed. RESULTS Sixty studies with a total of 6620 patients were included in the meta-analysis. Pooled sensitivity and specificity of GRE-MRE and SE-EPI-MRE showed high diagnostic accuracy and did not differ significantly. The area under the summary ROC curve for all stages of fibrosis differed significantly between DWI (0.83-0.88) and either GRE-MRE (0.95-0.97) or SE-EPI-MRE (0.95-0.99). Substantial heterogeneity was detected for all three imaging methods. CONCLUSIONS Both GRE-MRE and SE-EPI-MRE are highly accurate for detection of each liver fibrosis stage, with high potential to replace liver biopsy. Although DWI had a moderate accuracy in distinguishing liver fibrosis, it could be regarded as an alternative to MRE, since it is widely available and easily implemented in routine liver MRI.
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21
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Razek AAKA, Hafez MM, Mahmoud W, Ismail AR, Ali KM, Barakat TE. Diffusion tensor imaging of the spleen in prediction and grading of esophageal varices in cirrhotic children with portal hypertension. Jpn J Radiol 2021; 39:907-913. [PMID: 33914254 DOI: 10.1007/s11604-021-01123-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess diffusion tensor imaging (DTI) of spleen in prediction and grading of esophageal varices (OV) in cirrhotic children. METHODS This prospective study was conducted upon 30 children with cirrhotic children with OV and 10 age-gender matched controls that underwent DTI of abdomen. Mean diffusivity (MD) and fractional anisotropy (FA) of spleen were calculated and matched with the grading of OV at endoscopy and laboratory biomarkers of portal hypertension. RESULTS Mean ADC of spleen in patient was significantly different (p = 0.001) from that of controls by both reviewers respectively. The cutoff ADC measurement of the spleen used for prediction of OV was ≥ 0.75 and ≥ 0.76 × 10-3mm2/s with AUC was 0.993 and 0.997 for both reviewers respectively. The FA of the spleen in patient was different (p = 0.01) from of controls of both reviewers respectively. Cutoff FA of spleen used for prediction of OV was ≤ 0.35 and ≤ 0.36 for both observers respectively. ADC and FA of spleen was correlated with platelets count (r = - 0.713, 0.392; p = 0.001, 0.012) and prothrombin time (r = 0.518, - 0.380; p = 0.001, 0.016). CONCLUSION DTI metrics of spleen can predict and grade OV and correlated with laboratory biomarkers of portal hypertension.
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Affiliation(s)
| | - Mona Mohamed Hafez
- Cardiology Unit, Department of Pediatrics, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Walaa Mahmoud
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura University, Mansoura, 13551, Egypt
| | - Ahmed Ramadan Ismail
- Gastroenterology and Hepatology Unit, Department of Pediatrics, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Khadiga M Ali
- Department of Pathology, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Tarek Elsayed Barakat
- Gastroenterology and Hepatology Unit, Department of Pediatrics, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Charatcharoenwitthaya P, Sukonrut K, Korpraphong P, Pongpaibul A, Saiviroonporn P. Diffusion-weighted magnetic resonance imaging for the assessment of liver fibrosis in chronic viral hepatitis. PLoS One 2021; 16:e0248024. [PMID: 33662022 PMCID: PMC7932524 DOI: 10.1371/journal.pone.0248024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/14/2021] [Indexed: 12/16/2022] Open
Abstract
Background Accurate noninvasive methods for the assessment of liver fibrosis are urgently needed. This prospective study evaluated the diagnostic accuracy of diffusion-weighted magnetic resonance imaging (DWI) for the staging of liver fibrosis and proposed a diagnostic algorithm using DWI to identify cirrhosis in patients with chronic viral hepatitis. Methods One hundred twenty-one treatment-naïve patients with chronic hepatitis B or C were evaluated with DWI followed by liver biopsy on the same day. Breath-hold single-shot echo-planar DWI was performed to measure the apparent diffusion coefficient (ADC) of the liver and spleen. Normalized liver ADC was calculated as the ratio of liver ADC to spleen ADC. Results There was an inverse correlation between fibrosis stage and normalized liver ADC (p<0.05). For the prediction of fibrosis stage ≥2, stage ≥3, and cirrhosis, the area under the receiver-operating curve of normalized liver ADC was 0.603, 0.704, and 0.847, respectively. The normalized liver ADC value ≤1.02×10−3 mm2/s had 88% sensitivity, 81% specificity, 25% positive predictive value (PPV), and 99% negative predictive value (NPV) for the diagnosis of cirrhosis. Using a sequential approach with the Fibrosis-4 index followed by DWI, normalized liver ADC ≤1.02×10−3 mm2/s in patients with Fibrosis-4 >3.25 yielded an 80% PPV for cirrhosis, and a 100% NPV to exclude cirrhosis in patients with Fibrosis-4 between 1.45 and 3.25. Only 15.7% of patients would require a liver biopsy. This sequential strategy can reduce DWI examinations by 53.7%. Conclusion Normalized liver ADC measurement on DWI is an accurate and noninvasive tool for the diagnosis of cirrhosis in patients with chronic viral hepatitis.
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Affiliation(s)
- Phunchai Charatcharoenwitthaya
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- * E-mail:
| | - Kamonthip Sukonrut
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pornpim Korpraphong
- Radiology Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ananya Pongpaibul
- Pathology Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pairash Saiviroonporn
- Radiology Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Chevallier O, Wáng YXJ, Guillen K, Pellegrinelli J, Cercueil JP, Loffroy R. Evidence of Tri-Exponential Decay for Liver Intravoxel Incoherent Motion MRI: A Review of Published Results and Limitations. Diagnostics (Basel) 2021; 11:diagnostics11020379. [PMID: 33672277 PMCID: PMC7926368 DOI: 10.3390/diagnostics11020379] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/14/2021] [Accepted: 02/20/2021] [Indexed: 12/11/2022] Open
Abstract
Diffusion weighted imaging (DWI) and intravoxel incoherent motion (IVIM) have been explored to assess liver tumors and diffused liver diseases. IVIM reflects the microscopic translational motions that occur in voxels in magnetic resonance (MR) DWI. In biologic tissues, molecular diffusion of water and microcirculation of blood in the capillary network can be assessed using IVIM DWI. The most commonly applied model to describe the DWI signal is a bi-exponential model, with a slow compartment of diffusion linked to pure molecular diffusion (represented by the coefficient Dslow), and a fast compartment of diffusion, related to microperfusion (represented by the coefficient Dfast). However, high variance in Dfast estimates has been consistently shown in literature for liver IVIM, restricting its application in clinical practice. This variation could be explained by the presence of another very fast compartment of diffusion in the liver. Therefore, a tri-exponential model would be more suitable to describe the DWI signal. This article reviews the published evidence of the existence of this additional very fast diffusion compartment and discusses the performance and limitations of the tri-exponential model for liver IVIM in current clinical settings.
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Affiliation(s)
- Olivier Chevallier
- Image-Guided Therapy Center, Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (O.C.); (K.G.); (J.P.); (J.-P.C.)
| | - Yì Xiáng J. Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, China;
| | - Kévin Guillen
- Image-Guided Therapy Center, Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (O.C.); (K.G.); (J.P.); (J.-P.C.)
| | - Julie Pellegrinelli
- Image-Guided Therapy Center, Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (O.C.); (K.G.); (J.P.); (J.-P.C.)
| | - Jean-Pierre Cercueil
- Image-Guided Therapy Center, Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (O.C.); (K.G.); (J.P.); (J.-P.C.)
| | - Romaric Loffroy
- Image-Guided Therapy Center, Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (O.C.); (K.G.); (J.P.); (J.-P.C.)
- Correspondence: ; Tel.: +33-380-293-677
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Lai LY, Huang MP, Su S, Shu J. Liver Fibrosis Staging with Gadolinium Ethoxybenzyl Diethylenetriamine Penta-Acetic Acid-enhanced: A Systematic Review and Meta-analysis. Curr Med Imaging 2020; 17:854-863. [PMID: 33256584 DOI: 10.2174/1573405616666201130101229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/25/2020] [Accepted: 08/09/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE While liver biopsy is the golden standard for liver-fibrosis diagnosis, it is also invasive and has many limitations. Non-invasive techniques such as Magnetic Resonance Imaging (MRI) need to be further developed for liver fibrosis staging. This study aimed to evaluate the diagnostic accuracy of Gadolinium Ethoxybenzyl Diethylenetriamine Penta-acetic Acid (Gd-EOBDTPA)- enhanced MRI for liver fibrosis through systematic review and meta-analysis. METHODS This study comprehensively searched relevant article in PubMed, Embase, and the Cochrane Library published from 2004 to 2018 to find studies analyzing the diagnostic accuracy of Gd-EOB-DTPA-enhanced MRI for liver fibrosis. Two reviewers independently screened the retrieved articles, extracted the required data from the included studies, and evaluated the methodological quality of the studies. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and Summary Receiver Operating Characteristics (SROC) curve were assessed. RESULTS This study finally included 16 studies (n = 1,599) and selected a random-effects model based on the results of the I2 statistic to combine them. The areas under the SROC curve for the detection of F1 or greater, F2 or greater, F3 or greater, or F4 liver fibrosis were 0.8669, 0.8399, 0.8481, and 0.8858, respectively. CONCLUSION Gd-EOB-DTPA-enhanced MRI showed a good diagnostic performance for staging liver fibrosis, especially for F4 liver fibrosis.
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Affiliation(s)
- Lu-Yao Lai
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Meng-Ping Huang
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Song Su
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Jian Shu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
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Mostafa MA, Kamal O, Yassin A, Nagi MA, Ahmed OA, Ahmed HA. The diagnostic value of normalized ADC using spleen as reference organ in assessment liver fibrosis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00212-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To investigate the value of liver ADC normalization using spleen as a reference organ in liver fibrosis assessment compared to Fibroscan.
A total of 60 participants were included, 30 HCV positive patients and 30 in control group. We calculated mean spleen apparent diffusion coefficient (ADC), liver mean ADC, and normalized liver ADC (defined as the ratio of liver ADC to spleen ADC) which were compared between cirrhotic patients and the control group. Data was analyzed, and ROC was used to evaluate the performance of nADC.
Results
No significant difference between spleen ADC values of patient and control groups or in-between different fibrosis stages. A negative correlation between liver ADC and nADC values with increasing fibrosis stages. We also found that the mean liver ADC and nADC value in patients with hepatic fibrosis were significantly lower than that of control group (1.53 × 10−3 mm2/s vs 1.65 × 10−3 mm2/s). After analysis with ROC, nADC shows higher diagnostic performance compared to liver ADC. nADC area under the curve (AUC) was 0.878 for detection of stage ≥ F2 with sensitivity and specificity of 87% and 80% respectively while ADC AUC was 0.548 with sensitivity and specificity of 62% and 72% respectively (p = 0.021); ≥ F3 AUC of nADC was 0.891 with sensitivity and specificity of 88.7% and 80% respectively while ADC AUC is 0.603 with sensitivity and specificity of 72% and 72% respectively (p = 0.023), and F4 stage nADC AUC was 0.879 for with sensitivity and specificity of 90% and 80% respectively, while ADC AUC was 0.648 with sensitivity and specificity of 80% and 72% respectively (p = 0.054).
Conclusion
Normalized liver ADC using the spleen as reference organs increases the diagnostic performance of MR in evaluation liver fibrosis compared to ADC alone.
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Marti-Aguado D, Rodríguez-Ortega A, Alberich-Bayarri A, Marti-Bonmati L. Magnetic Resonance imaging analysis of liver fibrosis and inflammation: overwhelming gray zones restrict clinical use. Abdom Radiol (NY) 2020; 45:3557-3568. [PMID: 32857259 DOI: 10.1007/s00261-020-02713-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/30/2020] [Accepted: 08/18/2020] [Indexed: 12/13/2022]
Abstract
Magnetic resonance (MR) identification and grading of subjects with liver fibrosis and inflammation represents a clinical challenge. MR elastography plays a well-defined role in fibrosis estimation, but its use is not widely available in clinical settings. Given that liver MR is becoming the reference standard for fat and iron quantitation, there is a need to clarify whether there is any role for MR imaging in the concomitant evaluation of fibrosis and inflammation in this setting. This review summarizes the diagnostic estimations of different MR imaging parameters obtained from conventional non-contrast-enhanced multiple b values diffusion-weighted acquisitions, variable flip angles T1 relaxation maps and STIR images. Although some derived parameters have shown a significant correlation to histological scores, a small magnitude of effect with wide overlap across severity grades is the rule. Contrary to fat and iron quantification, the low precision and reproducibility of MR imaging metrics limits its clinical relevance in fibrosis and inflammation assessment. In a sequential clinical approach combining different methodologies, MR imaging has no applicability for ruling-out and low accuracy for ruling-in advanced fibrosis. Thereby, MR elastography remains as the only image method with high diagnostic accuracy for the detection of advanced fibrosis. Until date, inflammation remains in a gray zone where biopsy cannot be replaced, and further investigations are needed. The present review offers an in-depth discuss of the MR imaging diagnostic performance for the evaluation of liver fibrosis and inflammation, highlighting the need for scientific improvements.
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Affiliation(s)
- D Marti-Aguado
- Department of Gastroenterology and Hepatology, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain
- Biomedical Imaging Research Group (GIBI230 and PREBI), and Imaging La Fe Node at Distributed Network for Biomedical Imaging (ReDIB) Unique Scientific and Technical Infrastructures (ICTS), La Fe Health Research Institute, Valencia, Spain
| | - A Rodríguez-Ortega
- Biomedical Imaging Research Group (GIBI230 and PREBI), and Imaging La Fe Node at Distributed Network for Biomedical Imaging (ReDIB) Unique Scientific and Technical Infrastructures (ICTS), La Fe Health Research Institute, Valencia, Spain
| | - A Alberich-Bayarri
- Biomedical Imaging Research Group (GIBI230 and PREBI), and Imaging La Fe Node at Distributed Network for Biomedical Imaging (ReDIB) Unique Scientific and Technical Infrastructures (ICTS), La Fe Health Research Institute, Valencia, Spain
- Quantitative Imaging Biomarkers in Medicine, QUIBIM SL, Valencia, Spain
| | - L Marti-Bonmati
- Biomedical Imaging Research Group (GIBI230 and PREBI), and Imaging La Fe Node at Distributed Network for Biomedical Imaging (ReDIB) Unique Scientific and Technical Infrastructures (ICTS), La Fe Health Research Institute, Valencia, Spain.
- Radiology Department, La Fe University and Polytechnic Hospital, Av Fernando Abril Martorell 106, 46026, Valencia, Spain.
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Thomaides-Brears HB, Lepe R, Banerjee R, Duncker C. Multiparametric MR mapping in clinical decision-making for diffuse liver disease. Abdom Radiol (NY) 2020; 45:3507-3522. [PMID: 32761254 PMCID: PMC7593302 DOI: 10.1007/s00261-020-02684-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/12/2020] [Accepted: 07/22/2020] [Indexed: 02/07/2023]
Abstract
Accurate diagnosis, monitoring and treatment decisions in patients with chronic liver disease currently rely on biopsy as the diagnostic gold standard, and this has constrained early detection and management of diseases that are both varied and can be concurrent. Recent developments in multiparametric magnetic resonance imaging (mpMRI) suggest real potential to bridge the diagnostic gap between non-specific blood-based biomarkers and invasive and variable histological diagnosis. This has implications for the clinical care and treatment pathway in a number of chronic liver diseases, such as haemochromatosis, steatohepatitis and autoimmune or viral hepatitis. Here we review the relevant MRI techniques in clinical use and their limitations and describe recent potential applications in various liver diseases. We exemplify case studies that highlight how these techniques can improve clinical practice. These techniques could allow clinicians to increase their arsenals available to utilise on patients and direct appropriate treatments.
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Affiliation(s)
| | - Rita Lepe
- Texas Liver Institute, 607 Camden St, Suite 101, San Antonio, TX, 78215, USA
| | | | - Carlos Duncker
- Perspectum, 600 N. Pearl St. Suite 1960, Plaza of The Americas, Dallas, TX, 75201, USA
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28
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Riexinger A, Laun FB, Bickelhaupt S, Seuß H, Uder M, Hensel B, Saake M. On the dependence of the cardiac motion artifact on the breathing cycle in liver diffusion-weighted imaging. PLoS One 2020; 15:e0239743. [PMID: 33002028 PMCID: PMC7529231 DOI: 10.1371/journal.pone.0239743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/11/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose The purpose of this study was to investigate whether the cardiac motion artifact that regularly appears in diffusion-weighted imaging of the left liver lobe might be reduced by acquiring images in inspiration, when the coupling between heart and liver might be minimal. Materials and methods 43 patients with known or suspected focal liver lesions were examined at 1.5 T with breath hold acquisition, once in inspiration and once in expiration. Data were acquired with a diffusion-weighted echo planar imaging sequence and two b-values (b50 = 50 s/mm² and b800 = 800 s/mm²). The severity of the cardiac motion artifact in the left liver lobe was rated by two experienced radiologists for both b-values with a 5 point Likert scale. Additionally, the normalized signal S(b800)/S(b50) in the left liver lobe was computed. The Wilcoxon signed-rank test was used comparing the scores of the two readers obtained in inspiration and expiration, and to compare the normalized signal in inspiration and expiration. Results The normalized signal in inspiration was slightly higher than in expiration (0.349±0.077 vs 0.336±0.058), which would indicate a slight reduction of the cardiac motion artifact, but this difference was not significant (p = 0.24). In the qualitative evaluation, the readers did not observe a significant difference for b50 (reader 1: p = 0.61; reader 2: p = 0.18). For b800, reader 1 observed a significant difference of small effect size favouring expiration (p = 0.03 with a difference of mean Likert scores of 0.27), while reader 2 observed no significant difference (p = 0.62). Conclusion Acquiring the data in inspiration does not lead to a markedly reduced cardiac motion artifact in diffusion-weighted imaging of the left liver lobe and is in this regard not to be preferred over acquiring the data in expiration.
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Affiliation(s)
- Andreas Riexinger
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
- * E-mail:
| | | | | | - Hannes Seuß
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Bernhard Hensel
- Center for Medical Physics and Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Marc Saake
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
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Steger GL, Salesov E, Richter H, Reusch CE, Kircher PR, Del Chicca F. Evaluation of the changes in hepatic apparent diffusion coefficient and hepatic fat fraction in healthy cats during body weight gain. Am J Vet Res 2020; 81:796-803. [PMID: 32969732 DOI: 10.2460/ajvr.81.10.796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the change in mean hepatic apparent diffusion coefficient (ADC) and hepatic fat fraction (HFF) during body weight gain in cats by use of MRI. ANIMALS 12 purpose-bred adult neutered male cats. PROCEDURES The cats underwent general health and MRI examination at time 0 (before dietary intervention) and time 1 (after 40 weeks of being fed high-energy food ad libitum). Sequences included multiple-echo gradient-recalled echo MRI and diffusion-weighted MRI with 3 b values (0, 400, and 800 s/mm2). Variables (body weight and the HFF and ADC in selected regions of interest in the liver parenchyma) were compared between time points by Wilcoxon paired-sample tests. Relationships among variables were assessed with generalized mixed-effects models. RESULTS Median body weight was 4.5 and 6.5 kg, mean ± SD HFF was 3.39 ± 0.89% and 5.37 ± 1.92%, and mean ± SD hepatic ADC was 1.21 ± 0.08 × 10-3 mm2/s and 1.01 ± 0.2 × 10-3 mm2/s at times 0 and 1, respectively. Significant differences between time points were found for body weight, HFF, and ADC. The HFF was positively associated with body weight and ADC was negatively associated with HFF. CONCLUSIONS AND CLINICAL RELEVANCE Similar to findings in people, cats had decreasing hepatic ADC as HFF increased. Protons associated with fat tissue in the liver may reduce diffusivity, resulting in a lower ADC than in liver with lower HFF. Longer studies and evaluation of cats with different nutritional states are necessary to further investigate these findings.
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Intravoxel incoherent motion diffusion-weighted MRI for the characterization of inflammation in chronic liver disease. Eur Radiol 2020; 31:1347-1358. [PMID: 32876833 DOI: 10.1007/s00330-020-07203-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/10/2020] [Accepted: 08/18/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the diagnostic performance of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) for grading hepatic inflammation. METHODS In this retrospective cross-sectional dual-center study, 91 patients with chronic liver disease were recruited between September 2014 and September 2018. Patients underwent 3.0-T MRI examinations within 6 weeks from a liver biopsy. IVIM parameters, perfusion fraction (f), diffusion coefficient (D), and pseudo-diffusion coefficient (D*), were estimated using a voxel-wise nonlinear regression on DWI series (10 b-values from 0 to 800 s/mm2). The reference standard was histopathological analysis of hepatic inflammation grade, steatosis grade, and fibrosis stage. Intraclass correlation coefficients (ICC), univariate and multivariate correlation analyses, and areas under receiver operating characteristic curves (AUC) were assessed. RESULTS Parameters f, D, and D* had ICCs of 0.860, 0.839, and 0.916, respectively. Correlations of f, D, and D* with inflammation grade were ρ = - 0.70, p < 0.0001; ρ = 0.10, p = 0.35; and ρ = - 0.27, p = 0.010, respectively. When adjusting for fibrosis and steatosis, the correlation between f and inflammation (p < 0.0001) remained, and that between f and fibrosis was also significant to a lesser extent (p = 0.002). AUCs of f, D, and D* for distinguishing inflammation grades 0 vs. ≥ 1 were 0.84, 0.53, and 0.70; ≤ 1 vs. ≥ 2 were 0.88, 0.57, and 0.60; and ≤ 2 vs. 3 were 0.86, 0.54, and 0.65, respectively. CONCLUSION Perfusion fraction f strongly correlated, D very weakly correlated, and D* weakly correlated with inflammation. Among all IVIM parameters, f accurately graded inflammation and showed promise as a biomarker of hepatic inflammation. KEY POINTS • IVIM parameters derived from DWI series with 10 b-values are reproducible for liver tissue characterization. • This retrospective two-center study showed that perfusion fraction provided good diagnostic performance for distinguishing dichotomized grades of inflammation. • Fibrosis is a significant confounder on the association between inflammation and perfusion fraction.
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Kim J, Shin HJ, Yoon H, Han SJ, Koh H, Kim MJ, Lee MJ. Diffusion-Weighted Imaging for Differentiation of Biliary Atresia and Grading of Hepatic Fibrosis in Infants with Cholestasis. Korean J Radiol 2020; 22:253-262. [PMID: 32901459 PMCID: PMC7817632 DOI: 10.3348/kjr.2020.0055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 12/11/2022] Open
Abstract
Objective To determine whether the values of hepatic apparent diffusion coefficient (ADC) can differentiate biliary atresia (BA) from non-BA or be correlated with the grade of hepatic fibrosis in infants with cholestasis. Materials and Methods This retrospective cohort study included infants who received liver MRI examinations to evaluate cholestasis from July 2009 to October 2017. Liver ADC, ADC ratio of liver/spleen, aspartate aminotransferase to platelet ratio index (APRI), and spleen size were compared between the BA and non-BA groups. The diagnostic performances of all parameters for significant fibrosis (F3–4) were obtained by receiver-operating characteristics (ROCs) curve analysis. Results Altogether, 227 infants (98 males and 129 females, mean age = 57.2 ± 36.3 days) including 125 BA patients were analyzed. The absolute ADC difference between two reviewers was 0.10 mm2/s for both liver and spleen. Liver ADC value was specific (80.4%) and ADC ratio was sensitive (88.0%) for the diagnosis of BA with comparable performance. There were 33 patients with F0, 15 with F1, 71 with F2, 35 with F3, and 11 with F4. All four parameters of APRI (τ = 0.296), spleen size (τ = 0.312), liver ADC (τ = −0.206), and ADC ratio (τ = −0.288) showed significant correlation with fibrosis grade (all, p < 0.001). The cutoff values for significant fibrosis (F3–4) were 0.783 for APRI (area under the ROC curve [AUC], 0.721), 5.9 cm for spleen size (AUC, 0.719), 1.044 × 10−3 mm2/s for liver ADC (AUC, 0.673), and 1.22 for ADC ratio (AUC, 0.651). Conclusion Liver ADC values and ADC ratio of liver/spleen showed limited additional diagnostic performance for differentiating BA from non-BA and predicting significant hepatic fibrosis in infants with cholestasis.
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Affiliation(s)
- Jisoo Kim
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Joo Shin
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.,Severance Pediatric Liver Disease Research Group, Yonsei University College of Medicine, Seoul, Korea
| | - Haesung Yoon
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.,Severance Pediatric Liver Disease Research Group, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Joo Han
- Severance Pediatric Liver Disease Research Group, Yonsei University College of Medicine, Seoul, Korea.,Department of Pediatric Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hong Koh
- Severance Pediatric Liver Disease Research Group, Yonsei University College of Medicine, Seoul, Korea.,Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Joon Kim
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.,Severance Pediatric Liver Disease Research Group, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Jung Lee
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.,Severance Pediatric Liver Disease Research Group, Yonsei University College of Medicine, Seoul, Korea.
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Abdel Razek AAK, Abdalla A, Elfar R, Ashmalla GA, Ali K, Barakat T. Assessment of Diffusion Tensor Imaging Parameters of Hepatic Parenchyma for Differentiation of Biliary Atresia from Alagille Syndrome. Korean J Radiol 2020; 21:1367-1373. [PMID: 32729270 PMCID: PMC7689146 DOI: 10.3348/kjr.2019.0824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 03/22/2020] [Accepted: 04/18/2020] [Indexed: 12/11/2022] Open
Abstract
Objective To assess diffusion tensor imaging (DTI) parameters of the hepatic parenchyma for the differentiation of biliary atresia (BA) from Alagille syndrome (ALGS). Materials and Methods This study included 32 infants with BA and 12 infants with ALGS groups who had undergone DTI. Fractional anisotropy (FA) and mean diffusivity (MD) of the liver were calculated twice by two separate readers and hepatic tissue was biopsied. Statistical analyses were performed to determine the mean values of the two groups. The optimum cut-off values for DTI differentiation of BA and ALGS were calculated by receiver operating characteristic (ROC) analysis. Results The mean hepatic MD of BA (1.56 ± 0.20 and 1.63 ± 0.2 × 10−3 mm2/s) was significantly lower than that of ALGS (1.84 ± 0.04 and 1.79 ± 0.03 × 10−3 mm2/s) for both readers (r = 0.8, p = 0.001). Hepatic MD values of 1.77 and 1.79 × 10−3 mm2/s as a threshold for differentiating BA from ALGS showed accuracies of 82 and 79% and area under the curves (AUCs) of 0.90 and 0.91 for both readers, respectively. The mean hepatic FA of BA (0.34 ± 0.04 and 0.36 ± 0.04) was significantly higher (p = 0.01, 0.02) than that of ALGS (0.30 ± 0.06 and 0.31 ± 0.05) for both readers (r = 0.80, p = 0.001). FA values of 0.30 and 0.28 as a threshold for differentiating BA from ALGS showed accuracies of 75% and 82% and AUCs of 0.69 and 0.68 for both readers, respectively. Conclusion Hepatic DTI parameters are promising quantitative imaging parameters for the detection of hepatic parenchymal changes in BA and ALGS and may be an additional noninvasive imaging tool for the differentiation of BA from ALGS.
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Affiliation(s)
| | - Ahmed Abdalla
- Gastroenterology and Hepatology Unit, Mansoura Children Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Reda Elfar
- Gastroenterology and Hepatology Unit, Mansoura Children Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt
| | | | - Khadiga Ali
- Department of Pathology, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Tarik Barakat
- Gastroenterology and Hepatology Unit, Mansoura Children Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt
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Huang M, Lu X, Wang X, Shu J. Diffusion tensor imaging quantifying the severity of chronic hepatitis in rats. BMC Med Imaging 2020; 20:74. [PMID: 32615932 PMCID: PMC7333377 DOI: 10.1186/s12880-020-00466-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/04/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Diffusion tensor imaging (DTI) is mainly used for detecting white matter fiber in the brain. DTI was applied to assess fiber in liver disorders in previous studies. However, the data obtained have been insufficient in determining if DTI can be used to exactly stage chronic hepatitis. This study assessed the value of DTI for staging of liver fibrosis (F), necroinflammatory activity (A) and steatosis (S) with chronic hepatitis in rats. METHODS Seventy male Sprague-Dawley rats were divided into a control group(n = 10) and an experimental group(n = 60). The rat models of chronic hepatitis were established by abdominal subcutaneous injections of 40% CCl4. All of the rats underwent 3.0 T MRI. Regions of interest (ROIs) were subjected to DTI to estimate the MR parameters (rADC value and FA value). Histopathology was used as the reference standard. Multiple linear regression was used to analyze the associations between the MR parameters and pathology. The differences in the MR parameters among the pathological stages were evaluated by MANOVA or ANOVA. The LSD test was used to test for differences between each pair of groups. ROC analysis was also performed. RESULTS The count of each pathology was as follows: F0(n = 15), F1(n = 11), F2(n = 6), F3(n = 9), F4(n = 6); A0(n = 8), A1(n = 16), A2(n = 16), A3(n = 7); S0(n = 10), S1(n = 7), S2(n = 3), S3(n = 11), S4(n = 16). The rADC value had a negative correlation with liver fibrosis (r = - 0.392, P = 0.008) and inflammation (r = - 0.359, P = 0.015). The FA value had a positive correlation with fibrosis (r = 0.409, P = 0.005). Significant differences were found in the FA values between F4 and F0 ~ F3 (P = 0.03), while no significant differences among F0 ~ F3 were found (P > 0.05). The AUC of the FA value differentiating F4 from F0 ~ F3 was 0.909 (p < 0.001) with an 83.3% sensitivity and an 85.4% specificity when the FA value was at the cut-off of 588.089 (× 10- 6 mm2/s). CONCLUSION The FA value for DTI can distinguish early cirrhosis from normal, mild and moderate liver fibrosis, but the rADC value lacked the ability to differentiate among the fibrotic grades. Both the FA and rADC values were unable to discriminate the stages of necroinflammatory activity and steatosis.
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Affiliation(s)
- Mengping Huang
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou, Sichuan, 646000, People's Republic of China
| | - Xin Lu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou, Sichuan, 646000, People's Republic of China
| | - Xiaofeng Wang
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou, Sichuan, 646000, People's Republic of China
| | - Jian Shu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou, Sichuan, 646000, People's Republic of China.
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The role of diffusion tensor imaging for the assessment of liver fibrosis and inflammation in chronic viral hepatitis: A preliminary study. MARMARA MEDICAL JOURNAL 2020. [DOI: 10.5472/marumj.741724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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35
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Song J, Yu X, Song W, Guo D, Li C, Liu H, Zhang H, Zhou J, Liu Y. MRI
‐Based Radiomics Models Developed With Features of the Whole Liver and Right Liver Lobe: Assessment of Hepatic Inflammatory Activity in Chronic Hepatic Disease. J Magn Reson Imaging 2020; 52:1668-1678. [PMID: 32445618 DOI: 10.1002/jmri.27197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Junjie Song
- Department of Radiology Second Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Xiangling Yu
- Department of Radiology Second Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Wenlong Song
- Department of Radiology Second Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Dajing Guo
- Department of Radiology Second Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Chuanming Li
- Department of Radiology Second Affiliated Hospital of Chongqing Medical University Chongqing China
| | | | - Haiping Zhang
- Department of Radiology Second Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Jun Zhou
- Department of Radiology Second Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Yangyang Liu
- Department of Radiology Second Affiliated Hospital of Chongqing Medical University Chongqing China
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Diffusion Metrics for Staging Pancreatic Fibrosis and Correlating With Epithelial‐Mesenchymal Transition Markers in a Chronic Pancreatitis Rat Model at 11.7T MRI. J Magn Reson Imaging 2019; 52:197-206. [DOI: 10.1002/jmri.26995] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 12/20/2022] Open
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Phi van V, Reiner CS, Klarhoefer M, Ciritsis A, Eberhardt C, Wurnig MC, Rossi C. Diffusion tensor imaging of the abdominal organs: Influence of oriented intravoxel flow compartments. NMR IN BIOMEDICINE 2019; 32:e4159. [PMID: 31397037 DOI: 10.1002/nbm.4159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 06/10/2023]
Abstract
Water flow in partially oriented intravoxel compartments mimics an anisotropic fast-diffusion regime, which contributes to the signal attenuation in diffusion-weighted images. In the abdominal organs, this flow may reflect physiological fluid movements (eg, tubular urine flow in kidneys, or bile flow through the liver) and have a clinical relevance. This study investigated the influence of anisotropic intravoxel water flow on diffusion tensor imaging (DTI) of the abdominal organs. Diffusion-weighted images were acquired in five healthy volunteers using an EPI sequence with diffusion preparation (TR/TE: 1000 ms/71 ms; b-values: 0, 10, 20, 40, 70, 120, 250, 450, 700, 1000 s/mm2 ; 12 noncollinear diffusion-encoding directions). DTI of liver and kidneys was performed assuming (i) monoexponential decay of the diffusion-weighted signal, and (ii) accounting for potential anisotropy of the fast-diffusion compartments using a tensorial generalization of the IVIM model. Additionally, potential dependency of the metrics of the tensors from the anatomical location was evaluated. Significant differences in the metrics of the diffusion tensor (DT) were found in both liver and kidneys when comparing the two models. In both organs, the trace and the fractional anisotropy of the DT were significantly higher in the monoexponential model than when accounting for perfusion. The comparison of areas of the liver proximal to the hilum with distal regions and of renal cortex with the medulla also proved a location dependency of the size of the fast-diffusion compartments. Pseudo-diffusion correction in DTI enables the assessment of the solid parenchyma regardless of the organ perfusion or other pseudo-diffusive fluid movements. This may have a clinical relevance in the assessment of parenchymal pathologies (eg, liver fibrosis). The fast pseudo-diffusion components present a detectable anisotropy, which may reflect the hepatic microcirculation or other sources of mesoscopic fluid movement in the abdominal organs.
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Affiliation(s)
- Valerie Phi van
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Caecilia S Reiner
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | | | - Alexander Ciritsis
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Christian Eberhardt
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Moritz C Wurnig
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
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Wáng YXJ, Wang X, Wu P, Wang Y, Chen W, Chen H, Li J. Topics on quantitative liver magnetic resonance imaging. Quant Imaging Med Surg 2019; 9:1840-1890. [PMID: 31867237 DOI: 10.21037/qims.2019.09.18] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Liver magnetic resonance imaging (MRI) is subject to continuous technical innovations through advances in hardware, sequence and novel contrast agent development. In order to utilize the abilities of liver MR to its full extent and perform high-quality efficient exams, it is mandatory to use the best imaging protocol, to minimize artifacts and to select the most adequate type of contrast agent. In this article, we review the routine clinical MR techniques applied currently and some latest developments of liver imaging techniques to help radiologists and technologists to better understand how to choose and optimize liver MRI protocols that can be used in clinical practice. This article covers topics on (I) fat signal suppression; (II) diffusion weighted imaging (DWI) and intravoxel incoherent motion (IVIM) analysis; (III) dynamic contrast-enhanced (DCE) MR imaging; (IV) liver fat quantification; (V) liver iron quantification; and (VI) scan speed acceleration.
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Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
| | | | - Peng Wu
- Philips Healthcare (Suzhou) Co., Ltd., Suzhou 215024, China
| | - Yajie Wang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing 100084, China
| | - Weibo Chen
- Philips Healthcare, Shanghai 200072, China.,Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai 200062, China
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing 100084, China
| | - Jianqi Li
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai 200062, China
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Shin MK, Song JS, Hwang SB, Hwang HP, Kim YJ, Moon WS. Liver Fibrosis Assessment with Diffusion-Weighted Imaging: Value of Liver Apparent Diffusion Coefficient Normalization Using the Spleen as a Reference Organ. Diagnostics (Basel) 2019; 9:diagnostics9030107. [PMID: 31466404 PMCID: PMC6787628 DOI: 10.3390/diagnostics9030107] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/27/2019] [Accepted: 08/27/2019] [Indexed: 12/14/2022] Open
Abstract
Liver fibrosis staging is of great clinical importance because it is used to assess the severity of the underlying chronic liver disease. Among various imaging-based methods, apparent diffusion coefficient (ADC) measurement using diffusion-weighted imaging (DWI) has the potential to be used as an imaging biomarker for liver fibrosis assessment. In this study, we investigated the usefulness of liver ADC normalization using the spleen as a reference organ in liver fibrosis staging with 66 patients who underwent liver magnetic resonance imaging (MRI), transient elastography (TE), and surgical resection of a hepatic mass. ADC values of the liver (ADCliver) and spleen were analyzed, and the spleen was used for ADCliver normalization (nADCliver). ADCliver showed a weak negative correlation with TE (r = −0.246; p = 0.047) and fibrosis stage (r = −0.269; p = 0.029), while n ADCliver showed a moderate negative correlation with TE (r = −0.504; p < 0.001) and fibrosis stage (r = −0.579; p < 0.001). AUC values for nADCliver (0.777–0.875) were higher than those for ADCliver for each stage of fibrosis (0.596–0.713, p = 0.037–0.157). AUC values for TE (0.726–0.884) and nADCliver were not statistically different. In conclusion, normalized liver ADC can be useful in diagnosing liver fibrosis stage in patients with variable DWI acquisitions.
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Affiliation(s)
- Min Ki Shin
- Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju 54907, Korea
| | - Ji Soo Song
- Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju 54907, Korea.
- Research Institute of Clinical Medicine of Chonbuk National University, Jeonju 54907, Korea.
- Biomedical Research Institute of Chonbuk National University Hospital, Jeonju 54907, Korea.
| | - Seung Bae Hwang
- Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju 54907, Korea
- Research Institute of Clinical Medicine of Chonbuk National University, Jeonju 54907, Korea
- Biomedical Research Institute of Chonbuk National University Hospital, Jeonju 54907, Korea
| | - Hong Pil Hwang
- Department of Surgery, Chonbuk National University Medical School, Jeonju 54907, Korea
| | - Young Jun Kim
- Department of Radiology, Presbyterian Medical Center, Jeonju 54907, Korea
| | - Woo Sung Moon
- Department of Pathology, Chonbuk National University Medical School, Jeonju 54907, Korea
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Intravoxel incoherent motion imaging has the possibility to detect liver abnormalities in young Fontan patients with good hemodynamics. Cardiol Young 2019; 29:898-903. [PMID: 31250776 DOI: 10.1017/s1047951119001070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Liver fibrosis and cirrhosis are one of the critical complications in Fontan patients. However, there are no well-established non-invasive and quantitative techniques for evaluating liver abnormalities in Fontan patients. Intravoxel incoherent motion diffusion-weighted imaging with MRI is a non-invasive and quantitative method to evaluate capillary network perfusion and molecular diffusion. The objective of this study is to assess the feasibility of intravoxel incoherent motion imaging in evaluating liver abnormalities in Fontan children. MATERIALS AND METHODS Five consecutive Fontan patients and four age-matched healthy volunteers were included. Fontan patients were 12.8 ± 1.5 years old at the time of MRI scan. Intravoxel incoherent motion imaging parameters (D, D*, and f values) within the right hepatic lobe were compared. Laboratory test, ultrasonography, and cardiac MRI were also conducted in the Fontan patients. Results of cardiac catheterization conducted within one year of the intravoxel incoherent motion imaging were also examined. RESULTS In Fontan patients, laboratory test and liver ultrasonography showed almost normal liver condition. Cardiac catheter and MRI showed good Fontan circulation. Cardiac index was 2.61 ± 0.23 L/min/m2. Intravoxel incoherent motion imaging parameters D, D*, and f values were lower in Fontan patients compared with controls (D: 1.1 ± 0.0 versus 1.3 ± 0.2 × 10-3 mm2/second (p = 0.04), D*: 30.8 ± 24.8 versus 113.2 ± 25.6 × 10-3 mm2/second (p < 0.01), and f: 13.2 ± 3.1 versus 22.4 ± 2.4% (p < 0.01), respectively). CONCLUSIONS Intravoxel incoherent motion imaging is feasible for evaluating liver abnormalities in children with Fontan circulation.
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Emara DMM, Mohamed FSED, Abdullah AH, Ibrahim MAH, Ibrahim ME, Hassouna EM. Is diffusion weighted imaging adding value in diagnosis of focal hepatic lesions? Experience in 50 patients. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2013.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Verloh N, Probst U, Utpatel K, Zeman F, Brennfleck F, Werner JM, Fellner C, Stroszczynski C, Evert M, Wiggermann P, Haimerl M. Influence of hepatic fibrosis and inflammation: Correlation between histopathological changes and Gd-EOB-DTPA-enhanced MR imaging. PLoS One 2019; 14:e0215752. [PMID: 31083680 PMCID: PMC6513096 DOI: 10.1371/journal.pone.0215752] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 04/08/2019] [Indexed: 02/07/2023] Open
Abstract
Objective To evaluate the influence of an active inflammatory process in the liver on Gd-EOB-DTPA-enhanced MR imaging in patients with different degrees of fibrosis/cirrhosis. Material and methods Overall, a number of 91 patients (61 men and 30 women; mean age 58 years) were included in this retrospective study. The inclusion criteria for this study were Gd-EOB-DTPA-enhanced MRI of the liver and histopathological evaluation of fibrotic and inflammatory changes. T1-weighted VIBE sequences of the liver with fat suppression were evaluated to determine the relative signal change (RE) between native and hepatobiliary phase (20min). In simple and multiple linear regression analyses, the influence of liver fibrosis/cirrhosis (Ishak score) and the histopathological degree of hepatitis (Modified Hepatic Activity Index, mHAI) on RE were evaluated. Results RE decreased significantly with increasing liver fibrosis/cirrhosis (p < 0.001) and inflammation (mHAI, p = 0.004). In particular, a correlation between RE and periportal or periseptal boundary zone hepatitis (moth feeding necrosis, mHAI A, p = 0.001) and portal inflammation (mHAI D, p < 0.001) was observed. In multiple linear regression analysis, both the degree of inflammation and the degree of fibrosis were significant predictors for RE (p < 0.01). Conclusion The results of this study suggest that the MR-based hepatic enhancement index RE is not only influenced by the degree of fibrosis, but also by the degree of inflammation.
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Affiliation(s)
- N. Verloh
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
- * E-mail:
| | - U. Probst
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - K. Utpatel
- Department of Pathology, University Regensburg, Regensburg, Germany
| | - F Zeman
- Center for Clinical Trials, University Hospital Regensburg, Regensburg, Germany
| | - F. Brennfleck
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - J. M. Werner
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - C. Fellner
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - C. Stroszczynski
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - M. Evert
- Department of Pathology, University Regensburg, Regensburg, Germany
| | - P. Wiggermann
- Department of Radiology and Nuclear Medicine, Hospital Braunschweig, Braunschweig, Germany
| | - M. Haimerl
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
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Zhang Y, Peña-Nogales Ó, Holmes JH, Hernando D. Motion-robust and blood-suppressed M1-optimized diffusion MR imaging of the liver. Magn Reson Med 2019; 82:302-311. [PMID: 30859628 DOI: 10.1002/mrm.27735] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 02/10/2019] [Accepted: 02/20/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE To develop motion-robust, blood-suppressed diffusion-weighted imaging (DWI) of the liver with optimized diffusion encoding waveforms and evaluate the accuracy and reproducibility of quantitative apparent diffusion coefficient (ADC) measurements. METHODS A novel approach for the design of diffusion weighting waveforms, termed M1-optimized diffusion imaging (MODI), is proposed. MODI includes an echo time-optimized motion-robust diffusion weighting gradient waveform design, with a small nonzero first-moment motion sensitivity (M1) value to enable blood signal suppression. Experiments were performed in eight healthy volunteers and five patient volunteers. In each case, DW images and ADC maps were compared between acquisitions using standard monopolar waveforms, motion moment-nulled (M1-nulled and M1-M2-nulled) waveforms, and the proposed MODI approach. RESULTS Healthy volunteer experiments using MODI showed no significant ADC bias in the left lobe relative to the right lobe (p < .05) demonstrating robustness to cardiac motion, and no significant ADC bias with respect to monopolar-based ADC measured in the right lobe (p < .05), demonstrating blood signal suppression. In contrast, monopolar-based ADC showed significant bias in the left lobe relative to the right lobe (p < .01) due to its sensitivity to motion, and both M1-nulled and M1-M2-nulled-based ADC showed significant bias (p < .01) due to the lack of blood suppression. Preliminary patient results also suggest MODI may enable improved visualization and quantitative assessment of lesions throughout the entire liver. CONCLUSIONS This novel method for diffusion gradient waveform design enables DWI of the liver with high robustness to motion and suppression of blood signals, overcoming the limitations of conventional monopolar waveforms and moment-nulled waveforms, respectively.
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Affiliation(s)
- Yuxin Zhang
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Óscar Peña-Nogales
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin.,Laboratorio de Procesado de Imagen, Universidad de Valladolid, Valladolid, Spain
| | - James H Holmes
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Diego Hernando
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
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Questionable correlation of the apparent diffusion coefficient with the histological grade and microvascular invasion in small hepatocellular carcinoma. Clin Radiol 2019; 74:406.e19-406.e27. [PMID: 30826002 DOI: 10.1016/j.crad.2019.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 01/24/2019] [Indexed: 12/13/2022]
Abstract
AIM To evaluate the correlation between the apparent diffusion coefficient (ADC) and various histopathological parameters in small hepatocellular carcinomas (HCCs). MATERIALS AND METHODS In 143 surgically resected small HCCs, the mean and minimum ADC values, tumour-to-liver ADC ratio, and normalised ADC (ADC of the HCC/ADC of the spleen) were correlated to the tumour grade, microvascular invasion (MVI), cellularity, fatty change, degree of fibrosis, and lymphocytic infiltration using linear regression analysis, the Wilcoxon rank sum test, or Spearman's rank correlation. RESULTS No significant correlation was found between the ADC parameters and tumour grade. In the univariate analysis, the ADC ratio of the tumour was significantly correlated with MVI as well as the degree of fibrosis and lymphocyte infiltration of the HCC (p=0.017, 0.042, and 0.002, respectively). The ADC of the tumour was significantly correlated with the degree of lymphocyte infiltration of the HCC (p=0.049). In the multivariate analysis, the ADC ratio of the tumour was an independent parameter for MVI and the degree of lymphocyte infiltration of the HCC (p=0.034 and <0.001, respectively), and the ADC of the tumour was an independent parameter for the degree of lymphocyte infiltration of the HCC (p=0.009). There was no significant correlation between the other ADCs and pathological tumour parameters. CONCLUSION The tumour grade of small HCCs was not correlated with ADC parameters. The tumour-to-liver ADC ratio was a significant independent parameter for the degree of lymphocyte infiltration and MVI of small HCCs.
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Albrecht J, Polenz D, Kühl AA, Rogasch JMM, Leder A, Sauer IM, Babos M, Mócsai G, Beindorff N, Steffen IG, Brenner W, Koziolek EJ. Diffusion-weighted magnetic resonance imaging using a preclinical 1 T PET/MRI in healthy and tumor-bearing rats. EJNMMI Res 2019; 9:21. [PMID: 30796555 PMCID: PMC6386759 DOI: 10.1186/s13550-019-0489-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/08/2019] [Indexed: 02/07/2023] Open
Abstract
Background Hybrid positron emission tomography and magnetic resonance imaging (PET/MRI) scanners are increasingly used for both clinical and preclinical imaging. Especially functional MRI sequences such as diffusion-weighted imaging (DWI) are of great interest as they provide information on a molecular level, thus, can be used as surrogate biomarkers. Due to technical restrictions, MR sequences need to be adapted for each system to perform reliable imaging. There is, to our knowledge, no suitable DWI protocol for 1 Tesla PET/MRI scanners. We aimed to establish such DWI protocol with focus on the choice of b values, suitable for longitudinal monitoring of tumor characteristics in a rat liver tumor model. Material and methods DWI was first performed in 18 healthy rat livers using the scanner-dependent maximum of 4 b values (0, 100, 200, 300 s/mm2). Apparent diffusion coefficients (ADC) were calculated from different b value combinations and compared to the reference measurement with four b values. T2-weighted MRI and optimized DWI with best agreement between accuracy, scanning time, and system performance stability were used to monitor orthotopic hepatocellular carcinomas (HCC) in five rats of which three underwent additional 2-deoxy-2-(18F)fluoro-d-glucose(FDG)-PET imaging. ADCs were calculated for the tumor and the surrounding liver parenchyma and verified by histopathological analysis. Results Compared to the reference measurements, the combination b = 0, 200, 300 s/mm2 showed the highest correlation coefficient (rs = 0.92) and agreement while reducing the acquisition time. However, measurements with less than four b values yielded significantly higher ADCs (p < 0.001). When monitoring the HCC, an expected drop of the ADC was observed over time. These findings were paralleled by FDG-PET showing both an increase in tumor size and uptake heterogeneity. Interestingly, surrounding liver parenchyma also showed a change in ADC values revealing varying levels of inflammation by immunohistochemistry. Conclusion We established a respiratory-gated DWI protocol for a preclinical 1 T PET/MRI scanner allowing to monitor growth-related changes in ADC values of orthotopic HCC liver tumors. By monitoring the changes in tumor ADCs over time, different cellular stages were described. However, each study needs to adapt the protocol further according to their question to generate best possible results. Electronic supplementary material The online version of this article (10.1186/s13550-019-0489-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jakob Albrecht
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. .,German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany. .,German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
| | - Dietrich Polenz
- Department of Surgery, Campus Charité Mitte, Luisenstraße 64, 10117, Berlin, Germany.,Department of Surgery, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Mittelallee 4, 13353, Berlin, Germany
| | - Anja A Kühl
- iPATH.Berlin - Immunopathology for Experimental Models, Charité - Universitätsmedizin Berlin, Berlin Institute of Health, Core Unit, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Julian M M Rogasch
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Annekatrin Leder
- Department of Surgery, Campus Charité Mitte, Luisenstraße 64, 10117, Berlin, Germany.,Department of Surgery, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Mittelallee 4, 13353, Berlin, Germany
| | - Igor M Sauer
- Department of Surgery, Campus Charité Mitte, Luisenstraße 64, 10117, Berlin, Germany.,Department of Surgery, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Mittelallee 4, 13353, Berlin, Germany
| | - Magor Babos
- Mediso Medical Imaging Systems, Laborc utca 3, Budapest, 1037, Hungary
| | - Gabor Mócsai
- Mediso Medical Imaging Systems, Laborc utca 3, Budapest, 1037, Hungary
| | - Nicola Beindorff
- Berlin Experimental Radionuclide Imaging Center (BERIC), Charité - Universitätsmedizin Berlin, Südstraße 3, 13353, Berlin, Germany
| | - Ingo G Steffen
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Winfried Brenner
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,Berlin Experimental Radionuclide Imaging Center (BERIC), Charité - Universitätsmedizin Berlin, Südstraße 3, 13353, Berlin, Germany
| | - Eva J Koziolek
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
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Monoexponential and Biexponential Fitting of Diffusional Magnetic Resonance Imaging Signal Analysis for Prediction of Liver Fibrosis Severity. J Comput Assist Tomogr 2019; 43:857-862. [DOI: 10.1097/rct.0000000000000937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Intravoxel Incoherent Motion (IVIM) Diffusion-Weighted Imaging (DWI) in Patients with Liver Dysfunction of Chronic Viral Hepatitis: Segmental Heterogeneity and Relationship with Child-Turcotte-Pugh Class at 3 Tesla. Gastroenterol Res Pract 2018; 2018:2983725. [PMID: 30647733 PMCID: PMC6311737 DOI: 10.1155/2018/2983725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/19/2018] [Indexed: 12/11/2022] Open
Abstract
Background Few studies focused on the region of interest- (ROI-) related heterogeneity of liver intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI). The aim of the study was to evaluate the differences of liver IVIM parameters among liver segments in cirrhotic livers (chronic viral hepatitis). Material and Methods This was a retrospective study of 82 consecutive patients with chronic liver disease who underwent MRI examination at the Jinan Infectious Diseases Hospital between January 2015 and December 2016. IVIM DWI (seven different b values) was performed on a Siemens 3.0-T MRI scanner. Pure molecular diffusion (D), pseudodiffusion (D∗), and perfusion fraction (f) in different liver segments were evaluated. Results f, D, and D∗ were different among the liver segments (all p < 0.05), indicating heterogeneity in IVIM parameters among liver segments. f was consistently higher in Child-Turcotte-Pugh (CTP) class A compared with CTP class B + C (p < 0.01). D and D∗ were higher in CTP class A compared with CTP class B + C (p < 0.05). In patients with mean f value of >0.29, the AUC was 0.88 (95% CI: 0.81-0.96), with 86.8% sensitivity and 81.8% specificity for predicting CTP class A from CTP class B + C. Conclusion Liver IVIM could be a promising method for classifying the severity of segmental liver dysfunction of chronic viral hepatitis as evaluated by the CTP class, which provides a noninvasive alternative for evaluating segmental liver dysfunction with accurate selection of ROIs. Potentially it can be used to monitor the progression of CLD and LC in the future.
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Emara DM, Reda MM, Elwazzan DA. Utility of diffusion weighted imaging (DWI) in assessment of liver fibrosis. ALEXANDRIA JOURNAL OF MEDICINE 2018. [DOI: 10.1016/j.ajme.2017.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Doaa M. Emara
- Department of Radiology, Faculty of Medicine, Alexandria University, Egypt
| | - Marwa M. Reda
- Hepatobiliary Unit, Department of Internal Medicine, Faculty of Medicine, Alexandria University, Egypt
| | - Doaa A. Elwazzan
- Department of Tropical Medicine, Faculty of Medicine, Alexandria University, Egypt
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Yoshimaru D, Takatsu Y, Suzuki Y, Miyati T, Hamada Y, Funaki A, Tabata A, Maruyama C, Shimada M, Tobari M, Nishino T. Diffusion kurtosis imaging in the assessment of liver function: Its potential as an effective predictor of liver function. Br J Radiol 2018; 92:20170608. [PMID: 30358410 DOI: 10.1259/bjr.20170608] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES: We aimed to determine whether diffusion kurtosis imaging (DKI) analysis with the breath-hold technique can replace liver function results obtained from laboratory tests. METHODS: Patients (n = 79) suspected of having a hepatobiliary disease, and control group without liver diseases (n = 15) were examined with non-Gaussian diffusion-weighted imaging using a 3.0 T magnetic resonance imaging unit. Based on the findings of DKI, various blood serum parameters, including the indocyanine green (ICG) retention rate 15 min after an intravenous injection of ICG (ICG-R15) and mean kurtosis values and Child-Pugh and albumin-bilirubin (ALBI) scores, were calculated. In total, 17 patients were tested using ICG-R15. For evaluating liver function, correlations between the mean kurtosis value and the Child-Pugh score, ALBI score, and ICG-R15 value as indicators of liver function obtained from blood data were assessed using Spearman's rank correlation. In apparent diffusion coefficient as well, we assessed correlations with these indicators. RESULTS: The mean kurtosis value correlated with the Child-Pugh score (Spearman's rank-correlation coefficient, ρ = 0.3992; p < 0.0001). Moreover, the mean kurtosis value revealed a correlation with the ICG-R15 value (Spearman's rank-correlation coefficient, ρ = 0.5972; p = 0.00114). The correlation between the mean kurtosis value and the ALBI score was the poorest among these (Spearman's rank-correlation coefficient, ρ = 0.3395; p = 0.0008). CONCLUSION: Liver function correlating with the Child-Pugh score and ICG-R15 value can be quantitatively estimated using the mean kurtosis value obtained from DKI analysis. DKI analysis with the breath-hold technique can be used to determine liver function instead of performing laboratory tests. ADVANCES IN KNOWLEDGE: Previous studies have not evaluated liver function in vivo using DKI.
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Affiliation(s)
- Daisuke Yoshimaru
- 1 Department of Medical Technology, Tokyo Women's Medical University Yachiyo Medical Center , Yachiyo , Japan.,2 Division of Health Sciences, Graduate School of Medical Science, Kanazawa University, Kodatsuno , Kanazawa, Ishikawa , Japan
| | - Yasuo Takatsu
- 3 Department of Radiological Technology, Tokushima Bunri University , Kagawa , Japan
| | - Yuichi Suzuki
- 4 Department of Radiological Service, The University of Tokyo Hospital , Tokyo , Japan
| | - Toshiaki Miyati
- 2 Division of Health Sciences, Graduate School of Medical Science, Kanazawa University, Kodatsuno , Kanazawa, Ishikawa , Japan
| | - Yuhki Hamada
- 1 Department of Medical Technology, Tokyo Women's Medical University Yachiyo Medical Center , Yachiyo , Japan
| | - Ayumu Funaki
- 1 Department of Medical Technology, Tokyo Women's Medical University Yachiyo Medical Center , Yachiyo , Japan
| | - Ayumi Tabata
- 1 Department of Medical Technology, Tokyo Women's Medical University Yachiyo Medical Center , Yachiyo , Japan
| | - Chifumi Maruyama
- 1 Department of Medical Technology, Tokyo Women's Medical University Yachiyo Medical Center , Yachiyo , Japan
| | - Masahiko Shimada
- 5 Department of gastroenterological medicine, Tokyo Women's Medical University Yachiyo Medical Center , Yachiyo , Japan
| | - Maki Tobari
- 5 Department of gastroenterological medicine, Tokyo Women's Medical University Yachiyo Medical Center , Yachiyo , Japan
| | - Takayoshi Nishino
- 5 Department of gastroenterological medicine, Tokyo Women's Medical University Yachiyo Medical Center , Yachiyo , Japan
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50
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Sheng RF, Jin KP, Yang L, Wang HQ, Liu H, Ji Y, Fu CX, Zeng MS. Histogram Analysis of Diffusion Kurtosis Magnetic Resonance Imaging for Diagnosis of Hepatic Fibrosis. Korean J Radiol 2018; 19:916-922. [PMID: 30174481 PMCID: PMC6082766 DOI: 10.3348/kjr.2018.19.5.916] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 02/09/2018] [Indexed: 12/22/2022] Open
Abstract
Objective To investigate the diagnostic value of diffusion kurtosis imaging (DKI) histogram analysis in hepatic fibrosis staging. Materials and Methods Thirty-six rats were divided into carbon tetrachloride-induced fibrosis groups (6 rats per group for 2, 4, 6, and 8 weeks) and a control group (n = 12). MRI was performed using a 3T scanner. Histograms of DKI were obtained for corrected apparent diffusion (D), kurtosis (K) and apparent diffusion coefficient (ADC). Mean, median, skewness, kurtosis and 25th and 75th percentiles were generated and compared according to the fibrosis stage and inflammatory activity. Results A total of 35 rats were included, and 12, 5, 5, 6, and 7 rats were diagnosed as F0–F4. The mean, median, 25th and 75th percentiles, kurtosis of D map, median, 25th percentile, skewness of K map, and 75th percentile of ADC map demonstrated significant correlation with fibrosis stage (r = −0.767 to 0.339, p < 0.001 to p = 0.039). The fibrosis score was the independent variable associated with histogram parameters compared with inflammatory activity grade (p < 0.001 to p = 0.041), except the median of K map (p = 0.185). Areas under the receiver operating characteristic curve of D were larger than K and ADC maps in fibrosis staging, although no significant differences existed in pairwise comparisons (p = 0.0512 to p = 0.847). Conclusion Corrected apparent diffusion of DKI histogram analysis provides added value and better diagnostic performance to detect various liver fibrosis stages compared with ADC.
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Affiliation(s)
- Ruo-Fan Sheng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai 200032, China
| | - Kai-Pu Jin
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai 200032, China
| | - Li Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai 200032, China
| | - He-Qing Wang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai 200032, China
| | - Hao Liu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai 200032, China
| | - Yuan Ji
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Cai-Xia Fu
- MR Collaboration NEA, Siemens Ltd. China, Shanghai 201318, China
| | - Meng-Su Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai 200032, China
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