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Hojo E, Glaser KJ, Harada-Hayashi A, Le Y, Chen J, Hulshizer TC, Rossman PJ, Noyori S, Roberts N. Feasibility study of the application of magnetic resonance elastography (MRE) to measure oral posture related changes in stiffness of zygomaticus major muscle. Magn Reson Imaging 2024; 111:196-201. [PMID: 38723783 DOI: 10.1016/j.mri.2024.05.005] [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: 03/13/2024] [Revised: 04/20/2024] [Accepted: 05/06/2024] [Indexed: 05/24/2024]
Abstract
PURPOSE Development of a technique for measuring the mechanical properties of zygomaticus major (ZM) may aid advances in clinical treatments for correcting abnormal oral posture. The objective of this work was to demonstrate the feasibility of measuring the stiffness of ZM using an MR elastography technique that incorporates a custom local driver and a phase-gradient (PG) inversion. METHODS 2D MRE investigations were performed for 3 healthy subjects using a vibration frequency of 90 Hz to test the prediction that the stiffness of ZM would be greater in the mouth-open compared to the mouth-closed position. MRE wave images were acquired along the long axis of ZM and processed using a 2D spatial-temporal directional filter applied in the direction of wave propagation along the long axis of the muscle. Stiffness measurements were obtained by applying the PG technique to a 1D-profile drawn in the phase image of the first harmonic of the wave images and a one-tailed paired t-test was used to compare the ZM stiffness between the two mouth postures (p < 0.05). RESULTS The mean stiffness and standard deviation (SD) of ZM across the three participants in the mouth-closed and mouth-open postures was 6.75 kPa (SD 3.36 kPa) and 15.5 kPa (SD 5.15 kPa), respectively. Changes of ZM stiffness were significantly greater in the mouth-open than the mouth-closed posture (p = 0.038). CONCLUSION The feasibility of using the PG MRE technique to measure stiffness changes in a small muscle such as ZM for different mouth postures has been demonstrated. Further investigations are required in a larger cohort of participants to investigate the sensitivity and reproducibility of the technique for potential clinical application as well as in health and beauty related studies.
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Affiliation(s)
- Emi Hojo
- Centre for Reproductive Health (CRH), Institute for Regeneration and Repair (IRR), 4-5 Little France Drive, Edinburgh EH16 4UU, UK; Department of Radiology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Kevin J Glaser
- Department of Radiology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Ayako Harada-Hayashi
- Rohto Pharmaceutical Company, 1-8-1, Tatsumi-nishi, Ikunoku, Osaka 544-8666, Japan
| | - Yuan Le
- Department of Radiology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Jun Chen
- Department of Radiology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA; Department of Radiology, Nanjing Drum Tower Hospital, 321 Zhongshan Rd, Gulou, Nanjing, Jiangsu 210008, China; Resoundant, Inc., 421 1st Ave SW, Rochester, MN, USA
| | - Thomas C Hulshizer
- Department of Radiology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Phillip J Rossman
- Department of Radiology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Sachiko Noyori
- Rohto Pharmaceutical Company, 1-8-1, Tatsumi-nishi, Ikunoku, Osaka 544-8666, Japan
| | - Neil Roberts
- Centre for Reproductive Health (CRH), Institute for Regeneration and Repair (IRR), 4-5 Little France Drive, Edinburgh EH16 4UU, UK.
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2
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Mishra A, Cleveland RO. Rheological properties of porcine organs: measurements and fractional viscoelastic model. Front Bioeng Biotechnol 2024; 12:1386955. [PMID: 39148944 PMCID: PMC11324450 DOI: 10.3389/fbioe.2024.1386955] [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: 02/16/2024] [Accepted: 07/19/2024] [Indexed: 08/17/2024] Open
Abstract
The rheological properties of porcine heart, kidney, liver and brain were measured using dynamic oscillatory shear tests over a range of frequencies and shear strains. Frequency sweep tests were performed from 0.1 Hz to a maximum of 9.5 Hz at a shear strain of 0.1%, and strain sweep tests were carried out from 0.01% to 10% at 1 Hz. The effect of pre-compression of samples up to 10% axial strain was considered. The experimental measurements were fit to a Semi-Fractional Kelvin Voight (S-FKV) model. The model was then used to predict the stress relaxation in response to a step strain of 0.1%. The prediction was compared to experimental relaxation data for the porcine organ samples, and the results agreed to within 30%. In conclusion, this study measured the rheological properties of porcine organs and used a fractional viscoelastic model to describe the response in frequency and time domain.
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Affiliation(s)
- Aadarsh Mishra
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Robin O Cleveland
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
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3
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Burman Ingeberg M, Van Houten E, Zwanenburg JJM. Estimating the viscoelastic properties of the human brain at 7 T MRI using intrinsic MRE and nonlinear inversion. Hum Brain Mapp 2023; 44:6575-6591. [PMID: 37909395 PMCID: PMC10681656 DOI: 10.1002/hbm.26524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 10/04/2023] [Accepted: 10/09/2023] [Indexed: 11/03/2023] Open
Abstract
Intrinsic actuation magnetic resonance elastography (MRE) is a phase-contrast MRI technique that allows for in vivo quantification of mechanical properties of the brain by exploiting brain motion that arise naturally due to the cardiac pulse. The mechanical properties of the brain reflect its tissue microstructure, making it a potentially valuable parameter in studying brain disease. The main purpose of this study was to assess the feasibility of reconstructing the viscoelastic properties of the brain using high-quality 7 T MRI displacement measurements, obtained using displacement encoding with stimulated echoes (DENSE) and intrinsic actuation. The repeatability and sensitivity of the method for detecting normal regional variation in brain tissue properties was assessed as secondary goal. The displacement measurements used in this analysis were previously acquired for a separate study, where eight healthy subjects (27 ± 7 years) were imaged with repeated scans (spatial resolution approx. 2 mm isotropic, temporal resolution 75 ms, motion sensitivity 0.35 mm/2π for displacements in anterior-posterior and left-right directions, and 0.7 mm/2π for feet-head displacements). The viscoelastic properties of the brain were estimated using a subzone based non-linear inversion scheme. The results show comparable consistency to that of extrinsic MRE between the viscoelastic property maps obtained from repeated displacement measurements. The shear stiffness maps showed fairly consistent spatial patterns. The whole-brain repeatability coefficient (RC) for shear stiffness was (mean ± standard deviation) 8 ± 8% relative to the mean whole-brain stiffness, and the damping ratio RC was 28 ± 17% relative to the whole-brain damping ratio. The shear stiffness maps showed similar statistically significant regional trends as demonstrated in a publicly available atlas of viscoelastic properties obtained with extrinsic actuation MRE at 50 Hz. The damping ratio maps showed less consistency, likely due to data-model mismatch of describing the brain as a viscoelastic material under low frequencies. While artifacts induced by fluid flow within the brain remain a limitation of the technique in its current state, intrinsic actuation based MRE allow for consistent and repeatable estimation of the mechanical properties of the brain. The method provides enough sensitivity to investigate regional variation in such properties in the normal brain, which is likely sufficient to also investigate pathological changes.
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4
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Tipirneni-Sajja A, Brasher S, Shrestha U, Johnson H, Morin C, Satapathy SK. Quantitative MRI of diffuse liver diseases: techniques and tissue-mimicking phantoms. MAGMA (NEW YORK, N.Y.) 2023; 36:529-551. [PMID: 36515810 DOI: 10.1007/s10334-022-01053-z] [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: 08/03/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022]
Abstract
Quantitative magnetic resonance imaging (MRI) techniques are emerging as non-invasive alternatives to biopsy for assessment of diffuse liver diseases of iron overload, steatosis and fibrosis. For testing and validating the accuracy of these techniques, phantoms are often used as stand-ins to human tissue to mimic diffuse liver pathologies. However, currently, there is no standardization in the preparation of MRI-based liver phantoms for mimicking iron overload, steatosis, fibrosis or a combination of these pathologies as various sizes and types of materials are used to mimic the same liver disease. Liver phantoms that mimic specific MR features of diffuse liver diseases observed in vivo are important for testing and calibrating new MRI techniques and for evaluating signal models to accurately quantify these features. In this study, we review the liver morphology associated with these diffuse diseases, discuss the quantitative MR techniques for assessing these liver pathologies, and comprehensively examine published liver phantom studies and discuss their benefits and limitations.
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Affiliation(s)
- Aaryani Tipirneni-Sajja
- Department of Biomedical Engineering, The University of Memphis, Memphis, TN, USA.
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA.
| | - Sarah Brasher
- Department of Biomedical Engineering, The University of Memphis, Memphis, TN, USA
| | - Utsav Shrestha
- Department of Biomedical Engineering, The University of Memphis, Memphis, TN, USA
| | - Hayden Johnson
- Department of Biomedical Engineering, The University of Memphis, Memphis, TN, USA
| | - Cara Morin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sanjaya K Satapathy
- Northwell Health Center for Liver Diseases and Transplantation, Northshore University Hospital/Northwell Health, Manhasset, NY, USA
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5
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Pirasteh A, Periyasamy S, Meudt JJ, Liu Y, Lee LM, Schachtschneider KM, Schook LB, Gaba RC, Mao L, Said A, McMillan AB, Laeseke PF, Shanmuganayagam D. Staging Liver Fibrosis by Fibroblast Activation Protein Inhibitor PET in a Human-Sized Swine Model. J Nucl Med 2022; 63:1956-1961. [PMID: 35450958 PMCID: PMC9730920 DOI: 10.2967/jnumed.121.263736] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/07/2022] [Indexed: 01/11/2023] Open
Abstract
Current methods of staging liver fibrosis have notable limitations. We investigated the utility of PET in staging liver fibrosis by correlating liver uptake of 68Ga-labeled fibroblast activation protein inhibitor (FAPI) with histology in a human-sized swine model. Methods: Five pigs underwent baseline 68Ga-FAPI-46 (68Ga-FAPI) PET/MRI and liver biopsy, followed by liver parenchymal embolization, 8 wk of oral alcohol intake, endpoint 68Ga-FAPI PET/MRI, and necropsy. Regions of interest were drawn on baseline and endpoint PET images, and SUVmean was recorded. At the endpoint, liver sections corresponding to regions of interest were identified and cut out. Fibrosis was histologically evaluated using a modified METAVIR score for swine liver and quantitatively using collagen proportionate area (CPA). Box-and-whisker plots and linear regression were used to correlate SUVmean with METAVIR score and CPA, respectively. Results: Liver 68Ga-FAPI uptake strongly correlated with CPA (r = 0.89, P < 0.001). 68Ga-FAPI uptake was significantly and progressively higher across F2 and F3/F4 fibrosis stages, with a respective median SUVmean of 2.9 (interquartile range [IQR], 2.7-3.8) and 7.6 (IQR, 6.7-10.2) (P < 0.001). There was no significant difference between 68Ga-FAPI uptake of baseline liver and endpoint liver sections staged as F0/F1, with a respective median SUVmean of 1.7 (IQR, 1.3-2.0) and 1.7 (IQR, 1.5-1.8) (P = 0.338). Conclusion: The strong correlation between liver 68Ga-FAPI uptake and the histologic stage of liver fibrosis suggests that 68Ga-FAPI PET can play an impactful role in noninvasive staging of liver fibrosis, pending validation in patients.
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Affiliation(s)
- Ali Pirasteh
- Radiology and Medical Physics, University of Wisconsin–Madison, Madison, Wisconsin
| | - Sarvesh Periyasamy
- Radiology and Biomedical Engineering, University of Wisconsin–Madison, Madison, Wisconsin
| | - Jennifer Jean Meudt
- Animal and Dairy Sciences, University of Wisconsin–Madison, Madison, Wisconsin
| | - Yongjun Liu
- Pathology and Laboratory Medicine, University of Wisconsin–Madison, Madison, Wisconsin
| | - Laura M. Lee
- Research Animal Resources and Compliance, University of Wisconsin–Madison, Madison, Wisconsin
| | - Kyle M. Schachtschneider
- Radiology and Biochemistry and Molecular Genetics, University of Illinois at Chicago, Chicago, Illinois;,National Center for Supercomputing Applications, University of Illinois at Urbana–Champaign, Champaign, Illinois
| | - Lawrence B. Schook
- Animal Sciences, University of Illinois at Chicago, Chicago, Illinois;,Radiology/Interventional Radiology, University of Illinois at Chicago, Chicago, Illinois
| | - Ron C. Gaba
- Radiology/Interventional Radiology, University of Illinois at Chicago, Chicago, Illinois
| | - Lu Mao
- Biostatistics and Medical Informatics, University of Wisconsin–Madison, Madison, Wisconsin
| | - Adnan Said
- Medicine, Gastroenterology, and Hepatology, University of Wisconsin–Madison, Madison, Wisconsin;,William S. Middleton VA Medical Center, Madison, Wisconsin
| | - Alan Blair McMillan
- Radiology and Medical Physics, University of Wisconsin–Madison, Madison, Wisconsin
| | - Paul F. Laeseke
- Radiology and Biomedical Engineering, University of Wisconsin–Madison, Madison, Wisconsin
| | - Dhanansayan Shanmuganayagam
- Animal and Dairy Sciences, University of Wisconsin–Madison, Madison, Wisconsin;,Surgery, University of Wisconsin–Madison, Madison, Wisconsin; and,Center for Biomedical Swine Research and Innovation, University of Wisconsin–Madison, Madison, Wisconsin
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6
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McGarry M, Van Houten E, Sowinski D, Jyoti D, Smith DR, Caban-Rivera DA, McIlvain G, Bayly P, Johnson CL, Weaver J, Paulsen K. Mapping heterogenous anisotropic tissue mechanical properties with transverse isotropic nonlinear inversion MR elastography. Med Image Anal 2022; 78:102432. [PMID: 35358836 PMCID: PMC9122015 DOI: 10.1016/j.media.2022.102432] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 01/24/2022] [Accepted: 03/21/2022] [Indexed: 01/23/2023]
Abstract
The white matter tracts of brain tissue consist of highly-aligned, myelinated fibers; white matter is structurally anisotropic and is expected to exhibit anisotropic mechanical behavior. In vivo mechanical properties of tissue can be imaged using magnetic resonance elastography (MRE). MRE can detect and monitor natural and disease processes that affect tissue structure; however, most MRE inversion algorithms assume locally homogenous properties and/or isotropic behavior, which can cause artifacts in white matter regions. A heterogeneous, model-based transverse isotropic implementation of a subzone-based nonlinear inversion (TI-NLI) is demonstrated. TI-NLI reconstructs accurate maps of the shear modulus, damping ratio, shear anisotropy, and tensile anisotropy of in vivo brain tissue using standard MRE motion measurements and fiber directions estimated from diffusion tensor imaging (DTI). TI-NLI accuracy was investigated with using synthetic data in both controlled and realistic settings: excellent quantitative and spatial accuracy was observed and cross-talk between estimated parameters was minimal. Ten repeated, in vivo, MRE scans acquired from a healthy subject were co-registered to demonstrate repeatability of the technique. Good resolution of anatomical structures and bilateral symmetry were evident in MRE images of all mechanical property types. Repeatability was similar to isotropic MRE methods and well within the limits required for clinical success. TI-NLI MRE is a promising new technique for clinical research into anisotropic tissues such as the brain and muscle.
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7
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Yadav Y, Dunagan K, Khot R, Venkatesh SK, Port J, Galderisi A, Cobelli C, Wegner C, Basu A, Carter R, Basu R. Inhibition of 11β-Hydroxysteroid dehydrogenase-1 with AZD4017 in patients with nonalcoholic steatohepatitis or nonalcoholic fatty liver disease: A randomized, double-blind, placebo-controlled, phase II study. Diabetes Obes Metab 2022; 24:881-890. [PMID: 35014156 PMCID: PMC9135169 DOI: 10.1111/dom.14646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 11/29/2022]
Abstract
AIM To evaluate whether short-term treatment with a selective 11β-Hydroxysteroid dehydrogenase-1 (11β-HSD1) inhibitor, AZD4017, would block hepatic cortisol production and thereby decrease hepatic fat in patients with nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH), with or without type 2 diabetes (T2D). MATERIALS AND METHODS This was a randomized, double-blind, placebo-controlled, phase 2 study conducted at two sites. Key inclusion criteria were the presence of NAFLD or NASH on magnetic resonance imaging (MRI) or recent biopsy positive for NASH. Enrolled patients were randomly assigned (1:1) to AZD4017 or placebo for 12 weeks. Primary outcomes were between-group differences in mean change from baseline to week 12 in liver fat fraction (LFF) and conversion of 13 C cortisone to 13 C cortisol in the liver. RESULTS A total of 93 patients were randomized; 85 patients completed treatment. The mean (standard deviation [SD]) change in LFF was -0.667 (5.246) and 0.139 (4.323) in the AZD4017 and placebo groups (P = 0.441). For patients with NASH and T2D, the mean (SD) change in LFF was significantly improved in the AZD4017 versus the placebo group (-1.087 [5.374] vs. 1.675 [3.318]; P = 0.033). Conversion of 13 C cortisone to 13 C cortisol was blocked in all patients in the AZD4017 group. There were no significant between-group differences (AZD4017 vs. placebo) in changes in fibrosis, weight, levels of liver enzymes or lipids, or insulin sensitivity. CONCLUSION Although the study did not meet one of the primary outcomes, AZD4017 blocked the conversion of 13 C cortisone to 13 C cortisol in the liver in all patients who received the drug. In patients with NASH and T2D, AZD4017 improved liver steatosis versus placebo.
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Affiliation(s)
- Yogesh Yadav
- Division of EndocrinologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Kelly Dunagan
- Department of RadiologyMayo ClinicRochesterMinnesotaUSA
| | - Rachita Khot
- Division of Body Imaging, Department of Radiology and Medical ImagingUniversity of VirginiaCharlottesvilleVirginiaUSA
| | | | - John Port
- Department of RadiologyMayo ClinicRochesterMinnesotaUSA
| | - Alfonso Galderisi
- Department of Woman and Child's healthUniversity of PadovaPadovaVenetoItaly
| | - Claudio Cobelli
- Department of Woman and Child's healthUniversity of PadovaPadovaVenetoItaly
| | - Craig Wegner
- Retired from Emerging & Open Innovations Unit, IMED Biotech UnitAstraZenecaUSA
| | - Ananda Basu
- Division of EndocrinologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Rickey Carter
- Department of Quantitative Health SciencesMayo ClinicJacksonvilleFloridaUSA
| | - Rita Basu
- Division of EndocrinologyUniversity of VirginiaCharlottesvilleVirginiaUSA
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Herthum H, Carrillo H, Osses A, Uribe S, Sack I, Bertoglio C. Multiple motion encoding in phase-contrast MRI: A general theory and application to elastography imaging. Med Image Anal 2022; 78:102416. [PMID: 35334444 DOI: 10.1016/j.media.2022.102416] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/23/2021] [Accepted: 03/01/2022] [Indexed: 01/04/2023]
Abstract
While MRI allows to encode the motion of tissue in the magnetization's phase, it remains yet a challenge to obtain high fidelity motion images due to wraps in the phase for high encoding efficiencies. Therefore, we propose an optimal multiple motion encoding method (OMME) and exemplify it in Magnetic Resonance Elastography (MRE) data. OMME is formulated as a non-convex least-squares problem for the motion using an arbitrary number of phase-contrast measurements with different motion encoding gradients (MEGs). The mathematical properties of OMME are proved in terms of standard deviation and dynamic range of the motion's estimate for arbitrary MEGs combination which are confirmed using synthetically generated data. OMME's performance is assessed on MRE data from in vivo human brain experiments and compared to dual encoding strategies. The unwrapped images are further used to reconstruct stiffness maps and compared to the ones obtained using conventional unwrapping methods. OMME allowed to successfully combine several MRE phase images with different MEGs, outperforming dual encoding strategies in either motion-to-noise ratio (MNR) or number of successfully reconstructed voxels with good noise stability. This lead to stiffness maps with greater resolution of details than obtained with conventional unwrapping methods. The proposed OMME method allows for a flexible and noise robust increase in the dynamic range and thus provides wrap-free phase images with high MNR. In MRE, the method may be especially suitable when high resolution images with high MNR are needed.
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Affiliation(s)
- Helge Herthum
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universitt zu Berlin, and Berlin Institute of Health, Berlin, 10117, Germany
| | - Hugo Carrillo
- Center for Mathematical Modeling, Universidad de Chile, Santiago, 8370456, Chile; Bernoulli Institute, University of Groningen, Groningen, 9747AG, the Netherlands
| | - Axel Osses
- Center for Mathematical Modeling, Universidad de Chile, Santiago, 8370456, Chile; Department of Mathematical Engineering, Universidad de Chile, Santiago, 8370456, Chile; ANID - Millennium Nucleus in Cardiovascular Magnetic Resonance, Santiago, 7820436, Chile; ANID - Millenium Nucleus in Applied Control and Inverse Problems ACIP, Santiago, 7820436, Chile
| | - Sergio Uribe
- ANID - Millennium Nucleus in Cardiovascular Magnetic Resonance, Santiago, 7820436, Chile; Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, 7820436, Chile
| | - Ingolf Sack
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universitt zu Berlin, and Berlin Institute of Health, Berlin, 10117, Germany
| | - Cristóbal Bertoglio
- Bernoulli Institute, University of Groningen, Groningen, 9747AG, the Netherlands.
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9
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Kostallari E, Wei B, Sicard D, Li J, Cooper SA, Gao J, Dehankar M, Li Y, Cao S, Yin M, Tschumperlin DJ, Shah VH. Stiffness is associated with hepatic stellate cell heterogeneity during liver fibrosis. Am J Physiol Gastrointest Liver Physiol 2022; 322:G234-G246. [PMID: 34941452 PMCID: PMC8793867 DOI: 10.1152/ajpgi.00254.2021] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The fibrogenic wound-healing response in liver increases stiffness. Stiffness mechanotransduction, in turn, amplifies fibrogenesis. Here, we aimed to understand the distribution of stiffness in fibrotic liver, how it impacts hepatic stellate cell (HSC) heterogeneity, and identify mechanisms by which stiffness amplifies fibrogenic responses. Magnetic resonance elastography and atomic force microscopy demonstrated a heterogeneous distribution of liver stiffness at macroscopic and microscopic levels, respectively, in a carbon tetrachloride (CCl4) mouse model of liver fibrosis as compared with controls. High stiffness was mainly attributed to extracellular matrix dense areas. To identify a stiffness-sensitive HSC subpopulation, we performed single-cell RNA sequencing (scRNA-seq) on primary HSCs derived from healthy versus CCl4-treated mice. A subcluster of HSCs was matrix-associated with the most upregulated pathway in this subpopulation being focal adhesion signaling, including a specific protein termed four and a half LIM domains protein 2 (FHL2). In vitro, FHL2 expression was increased in primary human HSCs cultured on stiff matrix as compared with HSCs on soft matrix. Moreover, FHL2 knockdown inhibited fibronectin and collagen 1 expression, whereas its overexpression promoted matrix production. In summary, we demonstrate stiffness heterogeneity at the whole organ, lobular, and cellular level, which drives an amplification loop of fibrogenesis through specific focal adhesion molecular pathways.NEW & NOTEWORTHY The fibrogenic wound-healing response in liver increases stiffness. Here, macro and microheterogeneity of liver stiffness correlate with HSC heterogeneity in a hepatic fibrosis mouse model. Fibrogenic HSCs localized in stiff collagen-high areas upregulate the expression of focal adhesion molecule FHL2, which, in turn, promotes extracellular matrix protein expression. These results demonstrate that stiffness heterogeneity at the whole organ, lobular, and cellular level drives an amplification loop of fibrogenesis through specific focal adhesion molecular pathways.
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Affiliation(s)
- Enis Kostallari
- 1Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Bo Wei
- 1Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota,2Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Delphine Sicard
- 3Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Jiahui Li
- 4Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Shawna A. Cooper
- 5Department of Biochemistry and Molecular Biology, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, Minnesota
| | - Jinhang Gao
- 1Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota,2Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Mrunal Dehankar
- 6Division of Computational Biology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Ying Li
- 6Division of Computational Biology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Sheng Cao
- 1Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Meng Yin
- 4Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | - Vijay H. Shah
- 1Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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10
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Tang H, Li J, Zinker B, Boehm S, Mauer A, Rex-Rabe S, Glaser KJ, Fronheiser M, Bradstreet T, Nakao Y, Petrone T, Pena A, Villano M, Chow P, Malhi H, Charles ED, Hayes W, Ehman RL, Du S, Yin M. Evaluation of a PEGylated Fibroblast Growth Factor 21 Variant Using Novel Preclinical Magnetic Resonance Imaging and Magnetic Resonance Elastography in a Mouse Model of Nonalcoholic Steatohepatitis. J Magn Reson Imaging 2022; 56:712-724. [PMID: 35092323 PMCID: PMC9533307 DOI: 10.1002/jmri.28077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 01/07/2023] Open
Abstract
Background Treatments for nonalcoholic steatohepatitis (NASH) are urgently needed. Hepatic fat fraction and shear stiffness quantified by magnetic resonance imaging (MRI‐HFF) and magnetic resonance elastography (MRE‐SS), respectively, are biomarkers for hepatic steatosis and fibrosis. Purpose This study assessed the longitudinal effects of fibroblast growth factor 21 variant (polyethylene glycol [PEG]‐FGF21v) on MRI‐HFF and MRE‐SS in a NASH mouse model. Study Type Preclinical. Animal Model This study included a choline‐deficient, amino acid‐defined, high‐fat diet (CDAHFD) model and 6‐week‐old, male C57BL/6J mice (N = 78). Field Strength/Sequence This study was performed using: 3T: gradient‐echo two‐point Dixon and spin‐echo (SE) echo‐planar imaging elastography (200 Hz) and 7T: SE two‐point Dixon and SE elastography (200 Hz). Assessment MRI and MRE were performed before control diet (CD) or CDAHFD (BD), before PEG‐FGF21v dosing (baseline), and after PEG‐FGF21v treatment (WK4/8). Regions of interest for MRI‐HFF and MRE‐SS were delineated by J.L. and H.T. (>5 years of experience each). Fibrosis and steatosis were measured histologically after picrosirius red and H&E staining. Alkaline phosphatase, alanine transaminase, bile acids, and triglycerides (TGs) were measured. Statistical Tests Two‐tailed Dunnett's tests were used for statistical analysis; untreated CDAHFD or baseline was used for comparisons. Imaging and histology/biochemistry data were determined using Spearman correlations. Bayesian posterior distributions for MRE‐SS at WK8, posterior means, and 95% credible intervals were presented. Results CDAHFD significantly increased baseline MRI‐HFF (3T: 21.97% ± 0.29%; 7T: 40.12% ± 0.35%) and MRE‐SS (3T: 1.25 ± 0.02; 7T: 1.78 ± 0.06 kPa) vs. CD (3T: 3.45% ± 0.7%; 7T: 12.06% ± 1.4% and 3T: 1.01 ± 0.02; 7T: 0.89 ± 0.06 kPa). At 7T, PEG‐FGF21v significantly decreased MRI‐HFF (WK4: 28.97% ± 1.22%; WK8: 20.93% ± 1.15%) and MRE‐SS (WK4: 1.57 ± 0.04; WK8: 1.36 ± 0.05 kPa) vs. untreated (WK4: 36.36% ± 0.62%; WK8: 30.58% ± 0.81% and WK4: 2.03 ± 0.06; WK8: 2.01 ± 0.04 kPa); 3T trends were similar. WK8 SS posterior mean percent attenuation ratios (RDI) were −68% (−90%, −44%; 3T) and −64% (−78%, −52%; 7T). MRI‐HFF was significantly correlated with H&E (3T, r = 0.93; 7T, r = 0.94) and TGs (both, r = 0.92). Data Conclusions MRI‐HFF and MRE‐SS showed PEG‐FGF21v effects on hepatic steatosis and fibrosis across 3 and 7T, consistent with histological and biochemical data. Level of Evidence 1 Technical Efficacy Stage 2
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Affiliation(s)
- Haiying Tang
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Jiahui Li
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Amy Mauer
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kevin J Glaser
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Yasuhiko Nakao
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | - Patrick Chow
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Harmeet Malhi
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Wendy Hayes
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Richard L Ehman
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Shuyan Du
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Meng Yin
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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11
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Jung J, Loomba RR, Imajo K, Madamba E, Gandhi S, Bettencourt R, Singh S, Hernandez C, Valasek MA, Behling C, Richards L, Fowler K, Sirlin C, Nakajima A, Loomba R. MRE combined with FIB-4 (MEFIB) index in detection of candidates for pharmacological treatment of NASH-related fibrosis. Gut 2021; 70:1946-1953. [PMID: 33214165 PMCID: PMC8131405 DOI: 10.1136/gutjnl-2020-322976] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/10/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Patients with non-alcoholic fatty liver disease (NAFLD) with ≥stage 2 fibrosis are at increased risk for liver-related mortality and are candidates for pharmacological therapies for treatment of NAFLD. The aim of this prospective cohort study is to examine the diagnostic accuracy of MR elastography (MRE) combined with fibrosis-4 (FIB-4) in diagnosing ≥stage 2 fibrosis (candidates for pharmacological therapies). DESIGN This is a cross-sectional analysis of a prospective cohort (University of California at San Diego (UCSD)-NAFLD) including 238 consecutive patients with contemporaneous MRE and biopsy-proven NAFLD. Non-alcoholic steatohepatitis-Clinical Research Network-Histologic Scoring System was used to assess histology. The radiologist and pathologist were blinded to clinical, pathological and imaging data, respectively. Receiver operating characteristics (ROCs) were determined to examine the diagnostic accuracy of MRE and FIB-4 for diagnosis of ≥stage 2 fibrosis in NAFLD. We then validated these findings in an independent validation cohort derived from Yokohama City University in Japan (Japan-NAFLD Cohort; N=222 patients). RESULTS In the UCSD-NAFLD (training) Cohort, MRE demonstrated a clinically significant diagnostic accuracy for the detection of ≥stage 2 fibrosis with an area under the ROC curve (AUROC) of 0.93 (95% CI 0.90 to 0.97) vs FIB-4 with an AUROC of 0.78 (95% CI 0.71 to 0.85), which was both clinically and statistically significant (p<0.0001). We then combined MRE with FIB-4 (MRE ≥3.3 kPa and FIB-4 ≥1.6) to develop a clinical prediction rule to rule in ≥stage 2 fibrosis patients which had positive predictive value (PPV) of 97.1% (p<0.02) in the UCSD-NAFLD cohort (AUROC of 0.90 (95% CI 0.85 to 0.95)) which remained significant at PPV of 91.0% (p<0.003) in the Japan-NAFLD Cohort (AUROC of 0.84 (95% CI 0.78 to 0.89)). CONCLUSION MRE combined with FIB-4 (MEFIB) index may be used for non-invasive identification of candidates for (≥stage 2 fibrosis) pharmacological therapy among patients with NAFLD with a high PPV.
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Affiliation(s)
- Jinho Jung
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, La Jolla, United States
| | - Rohan R Loomba
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, La Jolla, United States
| | - Kento Imajo
- Yokohama City University Graduate School of Medicine, Department of Gastroenterology, Yokohama, Japan
| | - Egbert Madamba
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, La Jolla, United States
| | - Sanil Gandhi
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, La Jolla, United States
| | - Ricki Bettencourt
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, La Jolla, United States
| | - Seema Singh
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, La Jolla, United States
| | - Carolyn Hernandez
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, La Jolla, United States
| | - Mark A. Valasek
- University of California at San Diego, Department of Pathology, La Jolla, United States
| | - Cynthia Behling
- Sharp Medical Group, Department of Pathology, San Diego, United States
| | - Lisa Richards
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, La Jolla, United States
| | - Kathryn Fowler
- University of California at San Diego, Liver Imaging Group, Department of Radiology, La Jolla, United States
| | - Claude Sirlin
- University of California at San Diego, Liver Imaging Group, Department of Radiology, La Jolla, United States
| | - Atsushi Nakajima
- Yokohama City University Graduate School of Medicine, Department of Gastroenterology, Yokohama, Japan
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, La Jolla, California, USA .,Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
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12
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Rezakhani S, Gjorevski N, Lutolf MP. Extracellular matrix requirements for gastrointestinal organoid cultures. Biomaterials 2021; 276:121020. [PMID: 34280822 DOI: 10.1016/j.biomaterials.2021.121020] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/29/2021] [Accepted: 07/08/2021] [Indexed: 12/12/2022]
Abstract
Organoids are a new class of biological model systems that have garnered significant interest in the life sciences. When provided with the proper 3D matrix and biochemical factors, stem cells can self-organize and form tissue-specific organoids. Thus far, there has been a substantial effort to identify soluble niche components essential for organoid culture; however, the role of the solid extracellular matrix (ECM) as an essential element of the niche is still largely lacking. In this review, we discuss the importance of the ECM in intestinal, hepatic, and pancreatic organoid culture and how biomaterial-based approaches can be used to probe different ECM properties required for more physiologically and translationally relevant organoid models.
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Affiliation(s)
- S Rezakhani
- Laboratory of Stem Cell Bioengineering, Institute of Bioengineering, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015, Lausanne, Switzerland; Institute of Chemical Sciences and Engineering, School of Basic Sciences, EPFL, 1015, Lausanne, Switzerland
| | - N Gjorevski
- Laboratory of Stem Cell Bioengineering, Institute of Bioengineering, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015, Lausanne, Switzerland
| | - M P Lutolf
- Laboratory of Stem Cell Bioengineering, Institute of Bioengineering, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015, Lausanne, Switzerland; Institute of Chemical Sciences and Engineering, School of Basic Sciences, EPFL, 1015, Lausanne, Switzerland.
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13
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Magnetic resonance elastography to quantify liver disease severity in autosomal recessive polycystic kidney disease. Abdom Radiol (NY) 2021; 46:570-580. [PMID: 32757071 DOI: 10.1007/s00261-020-02694-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/30/2020] [Accepted: 07/25/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To evaluate whether liver and spleen magnetic resonance elastography (MRE) can measure the severity of congenital hepatic fibrosis (CHF) and portal hypertension (pHTN) in individuals with autosomal recessive polycystic kidney disease (ARPKD), and to examine correlations between liver MRE and ultrasound (US) elastography. METHODS Cross-sectional study of nine individuals with ARPKD and 14 healthy controls. MRE was performed to measure mean liver and spleen stiffness (kPa); US elastography was performed to measure point shear wave speed (SWS) in both liver lobes. We compared: (1) MRE liver and spleen stiffness between controls vs. ARPKD; and (2) MRE liver stiffness between participants with ARPKD without vs. with pHTN, and examined correlations between MRE liver stiffness, spleen length, platelet counts, and US elastography SWS. Receiver operating characteristic (ROC) analysis was performed to examine diagnostic accuracy of liver MRE. RESULTS Participants with ARPKD (median age 16.8 [IQR 13.3, 18.9] years) had higher median MRE liver stiffness than controls (median age 14.7 [IQR 9.7, 16.7 years) (2.55 vs. 1.92 kPa, p = 0.008), but MRE spleen stiffness did not differ. ARPKD participants with pHTN had higher median MRE liver stiffness than those without (3.60 kPa vs 2.49 kPa, p = 0.05). Liver MRE and US elastography measurements were strongly correlated. To distinguish ARPKD vs. control groups, liver MRE had 78% sensitivity and 93% specificity at a proposed cut-off of 2.48 kPa [ROC area 0.83 (95% CI 0.63-1.00)]. CONCLUSION Liver MRE may be a useful quantitative method to measure the severity of CHF and pHTN in individuals with ARPKD.
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14
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Alnazer I, Bourdon P, Urruty T, Falou O, Khalil M, Shahin A, Fernandez-Maloigne C. Recent advances in medical image processing for the evaluation of chronic kidney disease. Med Image Anal 2021; 69:101960. [PMID: 33517241 DOI: 10.1016/j.media.2021.101960] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/18/2020] [Accepted: 12/31/2020] [Indexed: 12/31/2022]
Abstract
Assessment of renal function and structure accurately remains essential in the diagnosis and prognosis of Chronic Kidney Disease (CKD). Advanced imaging, including Magnetic Resonance Imaging (MRI), Ultrasound Elastography (UE), Computed Tomography (CT) and scintigraphy (PET, SPECT) offers the opportunity to non-invasively retrieve structural, functional and molecular information that could detect changes in renal tissue properties and functionality. Currently, the ability of artificial intelligence to turn conventional medical imaging into a full-automated diagnostic tool is widely investigated. In addition to the qualitative analysis performed on renal medical imaging, texture analysis was integrated with machine learning techniques as a quantification of renal tissue heterogeneity, providing a promising complementary tool in renal function decline prediction. Interestingly, deep learning holds the ability to be a novel approach of renal function diagnosis. This paper proposes a survey that covers both qualitative and quantitative analysis applied to novel medical imaging techniques to monitor the decline of renal function. First, we summarize the use of different medical imaging modalities to monitor CKD and then, we show the ability of Artificial Intelligence (AI) to guide renal function evaluation from segmentation to disease prediction, discussing how texture analysis and machine learning techniques have emerged in recent clinical researches in order to improve renal dysfunction monitoring and prediction. The paper gives a summary about the role of AI in renal segmentation.
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Affiliation(s)
- Israa Alnazer
- XLIM-ICONES, UMR CNRS 7252, Université de Poitiers, France; Laboratoire commune CNRS/SIEMENS I3M, Poitiers, France; AZM Center for Research in Biotechnology and its Applications, EDST, Lebanese University, Beirut, Lebanon.
| | - Pascal Bourdon
- XLIM-ICONES, UMR CNRS 7252, Université de Poitiers, France; Laboratoire commune CNRS/SIEMENS I3M, Poitiers, France
| | - Thierry Urruty
- XLIM-ICONES, UMR CNRS 7252, Université de Poitiers, France; Laboratoire commune CNRS/SIEMENS I3M, Poitiers, France
| | - Omar Falou
- AZM Center for Research in Biotechnology and its Applications, EDST, Lebanese University, Beirut, Lebanon; American University of Culture and Education, Koura, Lebanon; Lebanese University, Faculty of Science, Tripoli, Lebanon
| | - Mohamad Khalil
- AZM Center for Research in Biotechnology and its Applications, EDST, Lebanese University, Beirut, Lebanon
| | - Ahmad Shahin
- AZM Center for Research in Biotechnology and its Applications, EDST, Lebanese University, Beirut, Lebanon
| | - Christine Fernandez-Maloigne
- XLIM-ICONES, UMR CNRS 7252, Université de Poitiers, France; Laboratoire commune CNRS/SIEMENS I3M, Poitiers, France
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15
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Sowinski DR, McGarry MDJ, Van Houten EEW, Gordon-Wylie S, Weaver JB, Paulsen KD. Poroelasticity as a Model of Soft Tissue Structure: Hydraulic Permeability Reconstruction for Magnetic Resonance Elastography in Silico. FRONTIERS IN PHYSICS 2021; 8:617582. [PMID: 36340954 PMCID: PMC9635531 DOI: 10.3389/fphy.2020.617582] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Magnetic Resonance Elastography allows noninvasive visualization of tissue mechanical properties by measuring the displacements resulting from applied stresses, and fitting a mechanical model. Poroelasticity naturally lends itself to describing tissue - a biphasic medium, consisting of both solid and fluid components. This article reviews the theory of poroelasticity, and shows that the spatial distribution of hydraulic permeability, the ease with which the solid matrix permits the flow of fluid under a pressure gradient, can be faithfully reconstructed without spatial priors in simulated environments. The paper describes an in-house MRE computational platform - a multi-mesh, finite element poroelastic solver coupled to an artificial epistemic agent capable of running Bayesian inference to reconstruct inhomogenous model mechanical property images from measured displacement fields. Building on prior work, the domain of convergence for inference is explored, showing that hydraulic permeabilities over several orders of magnitude can be reconstructed given very little prior knowledge of the true spatial distribution.
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Affiliation(s)
- Damian R. Sowinski
- Thayer School of Engineering, Dartmouth College, Hanover, NH, United States
| | | | | | - Scott Gordon-Wylie
- Thayer School of Engineering, Dartmouth College, Hanover, NH, United States
| | - John B Weaver
- Thayer School of Engineering, Dartmouth College, Hanover, NH, United States
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Dartmouth-Hitchcock Medical Center, Department of Radiology, Lebanon, NH, United States
| | - Keith D. Paulsen
- Thayer School of Engineering, Dartmouth College, Hanover, NH, United States
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Dartmouth-Hitchcock Medical Center, Center for Surgical Innovation, Lebanon, NH, United States
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Abstract
Application of MRE for noninvasive evaluation of renal fibrosis has great potential for noninvasive assessment in patients with chronic kidney disease (CKD). CKD leads to severe complications, which require dialysis or kidney transplant and could even result in death. CKD in native kidneys and interstitial fibrosis in allograft kidneys are the two major kidney fibrotic pathologies where MRE may be clinically useful. Both these conditions can lead to extensive morbidity, mortality, and high health care costs. Currently, biopsy is the standard method for renal fibrosis staging. This method of diagnosis is painful, invasive, limited by sampling bias, exhibits inter- and intraobserver variability, requires prolonged hospitalization, poses risk of complications and significant bleeding, and could even lead to death. MRE based methods can potentially be useful to noninvasively detect, stage, and monitor renal fibrosis, reducing the need for renal biopsy. In this chapter, we describe experimental procedure and step by step instructions to run MRE along with some illustrative applications. We also includes sections on how to perform data quality check and analysis methods.This publication is based upon work from the COST Action PARENCHIMA, a community-driven network funded by the European Cooperation in Science and Technology (COST) program of the European Union, which aims to improve the reproducibility and standardization of renal MRI biomarkers.
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Affiliation(s)
- Suraj D Serai
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
| | - Meng Yin
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Abstract
Magnetic resonance elastography (MRE) is an emerging imaging modality that maps the elastic properties of tissue such as the shear modulus. It allows for noninvasive assessment of stiffness, which is a surrogate for fibrosis. MRE has been shown to accurately distinguish absent or low stage fibrosis from high stage fibrosis, primarily in the liver. Like other elasticity imaging modalities, it follows the general steps of elastography: (1) apply a known cyclic mechanical vibration to the tissue; (2) measure the internal tissue displacements caused by the mechanical wave using magnetic resonance phase encoding method; and (3) infer the mechanical properties from the measured mechanical response (displacement), by generating a simplified displacement map. The generated map is called an elastogram.While the key interest of MRE has traditionally been in its application to liver, where in humans it is FDA approved and commercially available for clinical use to noninvasively assess degree of fibrosis, this is an area of active research and there are novel upcoming applications in brain, kidney, pancreas, spleen, heart, lungs, and so on. A detailed review of all the efforts is beyond the scope of this chapter, but a few specific examples are provided. Recent application of MRE for noninvasive evaluation of renal fibrosis has great potential for noninvasive assessment in patients with chronic kidney diseases. Development and applications of MRE in preclinical models is necessary primarily to validate the measurement against "gold-standard" invasive methods, to better understand physiology and pathophysiology, and to evaluate novel interventions. Application of MRE acquisitions in preclinical settings involves challenges in terms of available hardware, logistics, and data acquisition. This chapter will introduce the concepts of MRE and provide some illustrative applications.This publication is based upon work from the COST Action PARENCHIMA, a community-driven network funded by the European Cooperation in Science and Technology (COST) program of the European Union, which aims to improve the reproducibility and standardization of renal MRI biomarkers. This introduction chapter is complemented by another separate chapter describing the experimental protocol and data analysis.
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Affiliation(s)
- Suraj D Serai
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
| | - Meng Yin
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Sorrentino G, Rezakhani S, Yildiz E, Nuciforo S, Heim MH, Lutolf MP, Schoonjans K. Mechano-modulatory synthetic niches for liver organoid derivation. Nat Commun 2020; 11:3416. [PMID: 32651372 PMCID: PMC7351772 DOI: 10.1038/s41467-020-17161-0] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 06/11/2020] [Indexed: 12/27/2022] Open
Abstract
The recent demonstration that primary cells from the liver can be expanded in vitro as organoids holds enormous promise for regenerative medicine and disease modelling. The use of three-dimensional (3D) cultures based on ill-defined and potentially immunogenic matrices, however, hampers the translation of liver organoid technology into real-life applications. We here use chemically defined hydrogels for the efficient derivation of both mouse and human hepatic organoids. Organoid growth is found to be highly stiffness-sensitive, a mechanism independent of acto-myosin contractility and requiring instead activation of the Src family of kinases (SFKs) and yes-associated protein 1 (YAP). Aberrant matrix stiffness, on the other hand, results in compromised proliferative capacity. Finally, we demonstrate the establishment of biopsy-derived human liver organoids without the use of animal components at any step of the process. Our approach thus opens up exciting perspectives for the establishment of protocols for liver organoid-based regenerative medicine. 3D liver organoids hold great promise for regenerative medicine but the use of ill-defined matrices limits their potential. Here, the authors generate human and mouse liver organoids using a chemically defined matrix, and reveal a link between matrix stiffness and organoid growth that does not require acto-myosin contraction.
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Affiliation(s)
- Giovanni Sorrentino
- Laboratory of Metabolic Signaling, Institute of Bioengineering, School of Life Sciences and School of Engineering, Ecole Polytechnique Fédérale de Lausanne, 1015, Lausanne, Switzerland
| | - Saba Rezakhani
- Laboratory of Stem Cell Bioengineering, Institute of Bioengineering, School of Life Sciences and School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), 1015, Lausanne, Switzerland
| | - Ece Yildiz
- Laboratory of Metabolic Signaling, Institute of Bioengineering, School of Life Sciences and School of Engineering, Ecole Polytechnique Fédérale de Lausanne, 1015, Lausanne, Switzerland
| | - Sandro Nuciforo
- Department of Biomedicine, University Hospital Basel, University of Basel, 4031, Basel, Switzerland
| | - Markus H Heim
- Department of Biomedicine, University Hospital Basel, University of Basel, 4031, Basel, Switzerland.,Clinic of Gastroenterology and Hepatology, University Hospital Basel, University of Basel, 4031, Basel, Switzerland
| | - Matthias P Lutolf
- Laboratory of Stem Cell Bioengineering, Institute of Bioengineering, School of Life Sciences and School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), 1015, Lausanne, Switzerland.
| | - Kristina Schoonjans
- Laboratory of Metabolic Signaling, Institute of Bioengineering, School of Life Sciences and School of Engineering, Ecole Polytechnique Fédérale de Lausanne, 1015, Lausanne, Switzerland.
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Zhou IY, Clavijo Jordan V, Rotile NJ, Akam E, Krishnan S, Arora G, Krishnan H, Slattery H, Warner N, Mercaldo N, Farrar CT, Wellen J, Martinez R, Schlerman F, Tanabe KK, Fuchs BC, Caravan P. Advanced MRI of Liver Fibrosis and Treatment Response in a Rat Model of Nonalcoholic Steatohepatitis. Radiology 2020; 296:67-75. [PMID: 32343209 DOI: 10.1148/radiol.2020192118] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Liver biopsy is the reference standard to diagnose nonalcoholic steatohepatitis (NASH) but is invasive with potential complications. Purpose To evaluate molecular MRI with type 1 collagen-specific probe EP-3533 and allysine-targeted fibrogenesis probe Gd-Hyd, MR elastography, and native T1 to characterize fibrosis and to assess treatment response in a rat model of NASH. Materials and Methods MRI was performed prospectively (June-November 2018) in six groups of male Wistar rats (a) age- and (b) weight-matched animals received standard chow (n = 12 per group); (c) received choline-deficient, l-amino acid-defined, high-fat diet (CDAHFD) for 6 weeks or (d) 9 weeks (n = 8 per group); (e) were fed 6 weeks of CDAHFD and switched to standard chow for 3 weeks (n = 12); (f) were fed CDAHFD for 9 weeks with daily treatment of elafibranor beginning at week 6 (n = 14). Differences in imaging measurements and tissue analyses among groups were tested with one-way analysis of variance. The ability of each imaging measurement to stage fibrosis was quantified by using area under the receiver operating characteristic curve (AUC) with quantitative digital pathology (collagen proportionate area [CPA]) as reference standard. Optimal cutoff values for distinguishing advanced fibrosis were used to assess treatment response. Results AUC for distinguishing fibrotic (CPA >4.8%) from nonfibrotic (CPA ≤4.8%) livers was 0.95 (95% confidence interval [CI]: 0.91, 1.00) for EP-3533, followed by native T1, Gd-Hyd, and MR elastography with AUCs of 0.90 (95% CI: 0.83, 0.98), 0.84 (95% CI: 0.74, 0.95), and 0.65 (95% CI: 0.51, 0.79), respectively. AUCs for discriminating advanced fibrosis (CPA >10.3%) were 0.86 (95% CI: 0.76, 0.97), 0.96 (95% CI: 0.90, 1.01), 0.84 (95% CI: 0.70, 0.98), and 0.74 (95% CI: 0.63, 0.86) for EP-3533, Gd-Hyd, MR elastography, and native T1, respectively. Gd-Hyd MRI had the highest accuracy (24 of 26, 92%; 95% CI: 75%, 99%) in identifying responders and nonresponders in the treated groups compared with MR elastography (23 of 26, 88%; 95% CI: 70%, 98%), EP-3533 (20 of 26, 77%; 95% CI: 56%, 91%), and native T1 (14 of 26, 54%; 95% CI: 33%, 73%). Conclusion Collagen-targeted molecular MRI most accurately detected early onset of fibrosis, whereas the fibrogenesis probe Gd-Hyd proved most accurate for detecting treatment response. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Iris Y Zhou
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Veronica Clavijo Jordan
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Nicholas J Rotile
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Eman Akam
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Smitha Krishnan
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Gunisha Arora
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Hema Krishnan
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Hannah Slattery
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Noah Warner
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Nathaniel Mercaldo
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Christian T Farrar
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Jeremy Wellen
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Robert Martinez
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Franklin Schlerman
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Kenneth K Tanabe
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Bryan C Fuchs
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
| | - Peter Caravan
- From the Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Institute for Innovation in Imaging (I.Y.Z., V.C.J., N.J.R., E.A., H.K., H.S., N.W., C.T.F., P.C.), Division of Surgical Oncology (S.K., G.A., K.K.T., B.C.F.), and Institute for Technology Assessment, Department of Radiology (N.M.), Massachusetts General Hospital and Harvard Medical School, Charlestown, 149 13th St, Boston, MA 02129; and Pfizer, Cambridge, Mass (J.W., R.M., F.S.)
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20
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Yin Z, Murphy MC, Li J, Glaser KJ, Mauer AS, Mounajjed T, Therneau TM, Liu H, Malhi H, Manduca A, Ehman RL, Yin M. Prediction of nonalcoholic fatty liver disease (NAFLD) activity score (NAS) with multiparametric hepatic magnetic resonance imaging and elastography. Eur Radiol 2019; 29:5823-5831. [PMID: 30887196 DOI: 10.1007/s00330-019-06076-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/17/2019] [Accepted: 02/06/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To investigate the use of MR elastography (MRE)-derived mechanical properties (shear stiffness (|G*|) and loss modulus (G″)) and MRI-derived fat fraction (FF) to predict the nonalcoholic fatty liver disease (NAFLD) activity score (NAS) in a NAFLD mouse model. METHODS Eighty-nine male mice were studied, including 64 training and 25 independent testing animals. An MRI/MRE exam and histologic evaluation were performed. Pairwise, nonparametric comparisons and multivariate analyses were used to evaluate the relationships between the three imaging parameters (FF, |G*|, and G″) and histologic features. A virtual NAS score (vNAS) was generated by combining three imaging parameters with an ordinal logistic model (OLM) and a generalized linear model (GLM). The prediction accuracy was evaluated by ROC analyses. RESULTS The combination of FF, |G*|, and G″ predicted NAS > 1 with excellent accuracy in both training and testing sets (AUROC > 0.84). OLM and GLM predictive models misclassified 3/54 and 6/54 mice in the training, and 1/25 and 1/25 in the testing cohort respectively, in distinguishing between "not-NASH" and "definite-NASH." "Borderline-NASH" prediction was poorer in the training set, and no borderline-NASH mice were available in the testing set. CONCLUSION This preliminary study shows that multiparametric MRI/MRE can be used to accurately predict the NAS score in a NAFLD animal model, representing a promising alternative to liver biopsy for assessing NASH severity and treatment response. KEY POINTS • MRE-derived liver stiffness and loss modulus and MRI-assessed fat fraction can be used to predict NAFLD activity score (NAS) in our preclinical mouse model (AUROC > 0.84 for all NAS levels greater than 1). • The overall agreement between the histological-determined NASH diagnosis and the imaging-predicted NASH diagnosis is 80-92%. • The multiparametric hepatic MRI/MRE has great potential for noninvasively assessing liver disease severity and treatment efficacy.
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Affiliation(s)
- Ziying Yin
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Matthew C Murphy
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Jiahui Li
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Kevin J Glaser
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Amy S Mauer
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | | | - Terry M Therneau
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Heshan Liu
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Harmeet Malhi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Armando Manduca
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Richard L Ehman
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Meng Yin
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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21
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Attia D, Rodt T, Marquardt S, Hinrichs J, Meyer BC, Gebel M, Wacker F, Manns MP, Potthoff A. Shear wave elastography prior to transjugular intrahepatic portosystemic shunt may predict the decrease in hepatic vein pressure gradient. Abdom Radiol (NY) 2019; 44:1127-1134. [PMID: 30288582 DOI: 10.1007/s00261-018-1795-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure used to treat portal hypertension complications. Our aim was to evaluate liver and spleen stiffness measurement (LSM and SSM, respectively) changes using acoustic radiation force impulse imaging (ARFI) in comparison to Child-Pugh scores for predicting hepatic venous pressure gradient (HVPG) decreases after TIPS implantation. METHODS This prospective study included 31 consecutive clinically significant portal hypertension patients with TIPS indication. All patients received LSM and SSM before TIPS, at baseline, 2 days (follow-up 1) and 6 weeks (follow-up 2) post-implantation. HVPG was performed during the TIPS procedure. RESULTS The mean decrease in HVPG after TIPS was 63%. LSM and SSM decreased significantly between baseline and follow-up 2 (p < 0.001 and p < 0.001, respectively). At baseline, follow-up 1 and follow-up 2, significant correlations were detected between mean SSM and mean HVPG (p = 0.026; p = 0.018; p = 0.002, respectively). HVPG decreased to ≤ 10 mmHg in 61% of patients for which LSM, SSM, and Child-Pugh score were predictors (p = 0.033, p = 0.002 and p = 0.030, respectively). The area under the curve (AUC) for LSM, SSM, and Child-Pugh was 0.88, 0.90, and 0.84, respectively, with close sensitivity and specificity. SSM had the highest diagnostic accuracy for predicting an HVPG decrease to ≤ 10 mmHg in comparison to LSM and Child-Pugh score. CONCLUSION Spleen stiffness is superior to liver stiffness and Child-Pugh score as a non-invasive surveillance tool for evaluating patients with clinically significant portal hypertension (HVPG ≥ 10 mmHg) prior to TIPS.
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Affiliation(s)
- Dina Attia
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Beni-Suef University, Mokbel Street, Beni-Suef, 62511, Egypt.
| | - Thomas Rodt
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Steffen Marquardt
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jan Hinrichs
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Bernhard C Meyer
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Michael Gebel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Frank Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Andrej Potthoff
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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22
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Garteiser P, Doblas S, Van Beers BE. Magnetic resonance elastography of liver and spleen: Methods and applications. NMR IN BIOMEDICINE 2018; 31:e3891. [PMID: 29369503 DOI: 10.1002/nbm.3891] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/16/2017] [Accepted: 12/04/2017] [Indexed: 05/06/2023]
Abstract
The viscoelastic properties of the liver and spleen can be assessed with magnetic resonance elastography (MRE). Several actuators, MRI acquisition sequences and reconstruction algorithms have been proposed for this purpose. Reproducible results are obtained, especially when the examination is performed in standard conditions with the patient fasting. Accurate staging of liver fibrosis can be obtained by measuring liver stiffness or elasticity with MRE. Moreover, emerging evidence shows that assessing the tissue viscous parameters with MRE is useful for characterizing liver inflammation, non-alcoholic steatohepatitis, hepatic congestion, portal hypertension, and hepatic tumors. Further advances such as multifrequency acquisitions and compression-sensitive MRE may provide novel quantitative markers of hepatic and splenic mechanical properties that may improve the diagnosis of hepatic and splenic diseases.
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Affiliation(s)
- Philippe Garteiser
- Laboratory of Imaging Biomarkers, Center of Research on Inflammation, UMR 1149 INSERM-University Paris Diderot, Paris, France
| | - Sabrina Doblas
- Laboratory of Imaging Biomarkers, Center of Research on Inflammation, UMR 1149 INSERM-University Paris Diderot, Paris, France
| | - Bernard E Van Beers
- Laboratory of Imaging Biomarkers, Center of Research on Inflammation, UMR 1149 INSERM-University Paris Diderot, Paris, France
- Department of Radiology, Beaujon University Hospital Paris Nord, Clichy, France
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23
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Aponte Ortiz JA, Konik E, Eckert EC, Pepin KM, Greenberg-Worisek A. Premarket Approval Through the 510(k) Process: Lessons from the Translation Process of Magnetic Resonance Elastography. Clin Transl Sci 2018; 11:447-449. [PMID: 29969182 PMCID: PMC6132361 DOI: 10.1111/cts.12581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/11/2018] [Indexed: 12/19/2022] Open
Affiliation(s)
- Jaime A Aponte Ortiz
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota, USA.,University of Puerto Rico School of Medicine, San Juan, Puerto Rico, USA
| | - Ewa Konik
- Center for Clinical and Translational Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Elizabeth C Eckert
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota, USA.,Center for Clinical and Translational Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Kay M Pepin
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexandra Greenberg-Worisek
- Center for Clinical and Translational Research, Mayo Clinic, Rochester, Minnesota, USA.,Department of Epidemiology, Mayo Clinic, Rochester, Minnesota, USA
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24
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Bayly PV, Garbow JR. Pre-clinical MR elastography: Principles, techniques, and applications. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2018; 291:73-83. [PMID: 29705042 PMCID: PMC5943171 DOI: 10.1016/j.jmr.2018.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 01/07/2018] [Indexed: 05/09/2023]
Abstract
Magnetic resonance elastography (MRE) is a method for measuring the mechanical properties of soft tissue in vivo, non-invasively, by imaging propagating shear waves in the tissue. The speed and attenuation of waves depends on the elastic and dissipative properties of the underlying material. Tissue mechanical properties are essential for biomechanical models and simulations, and may serve as markers of disease, injury, development, or recovery. MRE is already established as a clinical technique for detecting and characterizing liver disease. The potential of MRE for diagnosing or characterizing disease in other organs, including brain, breast, and heart is an active research area. Studies involving MRE in the pre-clinical setting, in phantoms and artificial biomaterials, in the mouse, and in other mammals, are critical to the development of MRE as a robust, reliable, and useful modality.
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Affiliation(s)
- P V Bayly
- Mechanical Engineering and Materials Science, Washington University in Saint Louis, MO, USA.
| | - J R Garbow
- Radiology, Washington University School of Medicine, Saint Louis, MO, USA
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25
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Kim SR, Lerman LO. Diagnostic imaging in the management of patients with metabolic syndrome. Transl Res 2018; 194:1-18. [PMID: 29175480 PMCID: PMC5839955 DOI: 10.1016/j.trsl.2017.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/18/2017] [Accepted: 10/26/2017] [Indexed: 02/07/2023]
Abstract
Metabolic syndrome (MetS) is the constellation of metabolic risk factors that might foster development of type 2 diabetes and cardiovascular disease. Abdominal obesity and insulin resistance play a prominent role among all metabolic traits of MetS. Because intervention including weight loss can reduce these morbidity and mortality in MetS, early detection of the severity and complications of MetS could be useful. Recent advances in imaging modalities have provided significant insight into the development and progression of abdominal obesity and insulin resistance, as well as target organ injuries. The purpose of this review is to summarize advances in diagnostic imaging modalities in MetS that can be applied for evaluating each components and target organs. This may help in early detection, monitoring target organ injury, and in turn developing novel therapeutic target to alleviate and avert them.
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Affiliation(s)
- Seo Rin Kim
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minn
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minn.
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26
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Leung G, Kirpalani A, Szeto SG, Deeb M, Foltz W, Simmons CA, Yuen DA. Could MRI Be Used To Image Kidney Fibrosis? A Review of Recent Advances and Remaining Barriers. Clin J Am Soc Nephrol 2017; 12:1019-1028. [PMID: 28298435 PMCID: PMC5460707 DOI: 10.2215/cjn.07900716] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 12/19/2016] [Indexed: 12/18/2022]
Abstract
A key contributor to the progression of nearly all forms of CKD is fibrosis, a largely irreversible process that drives further kidney injury. Despite its importance, clinicians currently have no means of noninvasively assessing renal scar, and thus have historically relied on percutaneous renal biopsy to assess fibrotic burden. Although helpful in the initial diagnostic assessment, renal biopsy remains an imperfect test for fibrosis measurement, limited not only by its invasiveness, but also, because of the small amounts of tissue analyzed, its susceptibility to sampling bias. These concerns have limited not only the prognostic utility of biopsy analysis and its ability to guide therapeutic decisions, but also the clinical translation of experimental antifibrotic agents. Recent advances in imaging technology have raised the exciting possibility of magnetic resonance imaging (MRI)-based renal scar analysis, by capitalizing on the differing physical features of fibrotic and nonfibrotic tissue. In this review, we describe two key fibrosis-induced pathologic changes (capillary loss and kidney stiffening) that can be imaged by MRI techniques, and the potential for these new MRI-based technologies to noninvasively image renal scar.
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Affiliation(s)
- General Leung
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael’s Hospital
- Department of Medical Imaging, St. Michael’s Hospital
- Department of Medical Imaging
| | - Anish Kirpalani
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael’s Hospital
- Department of Medical Imaging, St. Michael’s Hospital
- Department of Medical Imaging
| | - Stephen G. Szeto
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael’s Hospital
| | - Maya Deeb
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael’s Hospital
| | | | - Craig A. Simmons
- Department of Mechanical and Industrial Engineering and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Darren A. Yuen
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael’s Hospital
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27
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Tan L, McGarry MDJ, Van Houten EEW, Ji M, Solamen L, Zeng W, Weaver JB, Paulsen KD. A numerical framework for interstitial fluid pressure imaging in poroelastic MRE. PLoS One 2017; 12:e0178521. [PMID: 28586393 PMCID: PMC5460821 DOI: 10.1371/journal.pone.0178521] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 05/15/2017] [Indexed: 11/18/2022] Open
Abstract
A numerical framework for interstitial fluid pressure imaging (IFPI) in biphasic materials is investigated based on three-dimensional nonlinear finite element poroelastic inversion. The objective is to reconstruct the time-harmonic pore-pressure field from tissue excitation in addition to the elastic parameters commonly associated with magnetic resonance elastography (MRE). The unknown pressure boundary conditions (PBCs) are estimated using the available full-volume displacement data from MRE. A subzone-based nonlinear inversion (NLI) technique is then used to update mechanical and hydrodynamical properties, given the appropriate subzone PBCs, by solving a pressure forward problem (PFP). The algorithm was evaluated on a single-inclusion phantom in which the elastic property and hydraulic conductivity images were recovered. Pressure field and material property estimates had spatial distributions reflecting their true counterparts in the phantom geometry with RMS errors around 20% for cases with 5% noise, but degraded significantly in both spatial distribution and property values for noise levels > 10%. When both shear moduli and hydraulic conductivity were estimated along with the pressure field, property value error rates were as high as 58%, 85% and 32% for the three quantities, respectively, and their spatial distributions were more distorted. Opportunities for improving the algorithm are discussed.
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Affiliation(s)
- Likun Tan
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, United States of America
| | - Matthew D. J. McGarry
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, United States of America
| | - Elijah E. W. Van Houten
- Department of Mechanical Engineering, University de Sherbrooke, Sherbrooke, Quebec J1K 2R1, Canada
| | - Ming Ji
- Department of Molecular Biology and Genetics, Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States of America
| | - Ligin Solamen
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, United States of America
| | - Wei Zeng
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, United States of America
| | - John B. Weaver
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, United States of America
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756 United States of America
| | - Keith D. Paulsen
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, United States of America
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756 United States of America
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Zhu B, Wei L, Rotile N, Day H, Rietz T, Farrar CT, Lauwers GY, Tanabe KK, Rosen B, Fuchs BC, Caravan P. Combined magnetic resonance elastography and collagen molecular magnetic resonance imaging accurately stage liver fibrosis in a rat model. Hepatology 2017; 65:1015-1025. [PMID: 28039886 PMCID: PMC5319882 DOI: 10.1002/hep.28930] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 11/04/2016] [Indexed: 12/12/2022]
Abstract
UNLABELLED Hepatic fibrosis is associated with an overproduction of matrix proteins and a pathological increase of liver stiffness. Noninvasive magnetic resonance (MR) quantification of matrix can be assessed with a collagen-binding molecular MR probe and stiffness by MR elastography, complementary techniques. This study used both imaging techniques to more accurately stage hepatic fibrosis in a rat model. Thirty rats with varying levels of diethylnitrosamine-induced liver fibrosis were imaged before and 45 minutes after injection of collagen-specific probe EP-3533. MR elastography was performed in the same imaging session. Changes in liver relaxation rate post-EP-3533 and liver stiffness were compared to the collagen proportional area determined by histology and to Ishak scoring using receiver operating characteristic analysis. Collagen imaging was most sensitive to early fibrosis, while elastography was more sensitive to advanced fibrosis. This complementary feature enabled the formulation of a composite model using multivariate analysis of variance. This model incorporated the discriminating advantages of both MR techniques, resulting in more accurate staging throughout fibrotic progression. CONCLUSION Collagen molecular MR imaging is complementary to MR elastography, and combining the two techniques in a single exam leads to increased diagnostic accuracy for all stages of fibrosis. (Hepatology 2017;65:1015-1025).
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Affiliation(s)
- Bo Zhu
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth St., Suite 2301, Charlestown, MA 02129, United States
| | - Lan Wei
- Surgical Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, WRN 401, 55 Fruit St., Boston, MA 02114 United States
| | - Nicholas Rotile
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth St., Suite 2301, Charlestown, MA 02129, United States
| | - Helen Day
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth St., Suite 2301, Charlestown, MA 02129, United States
| | - Tyson Rietz
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth St., Suite 2301, Charlestown, MA 02129, United States
| | - Christian T. Farrar
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth St., Suite 2301, Charlestown, MA 02129, United States
| | - Gregory Y. Lauwers
- Pathology, Massachusetts General Hospital and Harvard Medical School, WRN 2, 55 Fruit St., Boston, MA, 02114, United States
| | - Kenneth K. Tanabe
- Surgical Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, WRN 401, 55 Fruit St., Boston, MA 02114 United States
| | - Bruce Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth St., Suite 2301, Charlestown, MA 02129, United States
| | - Bryan C. Fuchs
- Surgical Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, WRN 401, 55 Fruit St., Boston, MA 02114 United States
| | - Peter Caravan
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth St., Suite 2301, Charlestown, MA 02129, United States
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29
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Yin M, Glaser KJ, Manduca A, Mounajjed T, Malhi H, Simonetto DA, Wang R, Yang L, Mao SA, Glorioso JM, Elgilani FM, Ward CJ, Harris PC, Nyberg SL, Shah VH, Ehman RL. Distinguishing between Hepatic Inflammation and Fibrosis with MR Elastography. Radiology 2017; 284:694-705. [PMID: 28128707 DOI: 10.1148/radiol.2017160622] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Purpose To investigate the utility of magnetic resonance (MR) elastography-derived mechanical properties in the discrimination of hepatic inflammation and fibrosis in the early stages of chronic liver diseases. Materials and Methods All studies were approved by the institutional animal care and use committee. A total of 187 animals were studied, including 182 mice and five pigs. These animals represented five different liver diseases with a varying combination and extent of hepatic inflammation, fibrosis, congestion, and portal hypertension. Multifrequency three-dimensional MR elastography was performed, and shear stiffness, storage modulus, shear loss modulus, and damping ratio were calculated for all animals. Necroinflammation, fibrosis, and portal pressure were either histologically scored or biochemically and physically quantified in all animals. Two-sided Welch t tests were used to evaluate mean differences between disease and control groups. Spearman correlation analyses were used to evaluate the relationships between mechanical parameters and quantitative fibrosis extent (hydroxyproline concentration) and portal pressure. Results Liver stiffness and storage modulus increased with progressively developed fibrosis and portal hypertension (mean stiffness at 80 Hz and 48-week feeding, 0.51 kPa ± 0.12 in the steatohepatitis group vs 0.29 kPa ± 0.01 in the control group; P = .02). Damping ratio and shear loss modulus can be used to distinguish inflammation from fibrosis at early stages of disease, even before the development of histologically detectable necroinflammation and fibrosis (mean damping ratio at 80 Hz and 20-week feeding, 0.044 ± 0.012 in the steatohepatitis group vs 0.014 ± 0.008 in the control group; P < .001). Damping ratio and liver stiffness vary differently with respect to cause of portal hypertension (ie, congestion- or cirrhosis-induced hypertension). These differentiation abilities have frequency-dependent variations. Conclusion Liver stiffness and damping ratio measurements can extend hepatic MR elastography to potentially enable assessment of necroinflammatory, congestive, and fibrotic processes of chronic liver diseases. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Meng Yin
- From the Departments of Radiology (M.Y., K.J.G., A.M., R.L.E.) and Physiology and Biomedical Engineering (A.M.) and the Divisions of Anatomic Pathology (T.M.), Gastroenterology and Hepatology (H.M., D.A.S., R.W., L.Y., V.H.S.), Transplantation Surgery (S.A.M., J.M.G., F.M.E., S.L.N.), and Nephrology and Hypertension (C.J.W., P.C.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Kevin J Glaser
- From the Departments of Radiology (M.Y., K.J.G., A.M., R.L.E.) and Physiology and Biomedical Engineering (A.M.) and the Divisions of Anatomic Pathology (T.M.), Gastroenterology and Hepatology (H.M., D.A.S., R.W., L.Y., V.H.S.), Transplantation Surgery (S.A.M., J.M.G., F.M.E., S.L.N.), and Nephrology and Hypertension (C.J.W., P.C.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Armando Manduca
- From the Departments of Radiology (M.Y., K.J.G., A.M., R.L.E.) and Physiology and Biomedical Engineering (A.M.) and the Divisions of Anatomic Pathology (T.M.), Gastroenterology and Hepatology (H.M., D.A.S., R.W., L.Y., V.H.S.), Transplantation Surgery (S.A.M., J.M.G., F.M.E., S.L.N.), and Nephrology and Hypertension (C.J.W., P.C.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Taofic Mounajjed
- From the Departments of Radiology (M.Y., K.J.G., A.M., R.L.E.) and Physiology and Biomedical Engineering (A.M.) and the Divisions of Anatomic Pathology (T.M.), Gastroenterology and Hepatology (H.M., D.A.S., R.W., L.Y., V.H.S.), Transplantation Surgery (S.A.M., J.M.G., F.M.E., S.L.N.), and Nephrology and Hypertension (C.J.W., P.C.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Harmeet Malhi
- From the Departments of Radiology (M.Y., K.J.G., A.M., R.L.E.) and Physiology and Biomedical Engineering (A.M.) and the Divisions of Anatomic Pathology (T.M.), Gastroenterology and Hepatology (H.M., D.A.S., R.W., L.Y., V.H.S.), Transplantation Surgery (S.A.M., J.M.G., F.M.E., S.L.N.), and Nephrology and Hypertension (C.J.W., P.C.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Douglas A Simonetto
- From the Departments of Radiology (M.Y., K.J.G., A.M., R.L.E.) and Physiology and Biomedical Engineering (A.M.) and the Divisions of Anatomic Pathology (T.M.), Gastroenterology and Hepatology (H.M., D.A.S., R.W., L.Y., V.H.S.), Transplantation Surgery (S.A.M., J.M.G., F.M.E., S.L.N.), and Nephrology and Hypertension (C.J.W., P.C.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Ruisi Wang
- From the Departments of Radiology (M.Y., K.J.G., A.M., R.L.E.) and Physiology and Biomedical Engineering (A.M.) and the Divisions of Anatomic Pathology (T.M.), Gastroenterology and Hepatology (H.M., D.A.S., R.W., L.Y., V.H.S.), Transplantation Surgery (S.A.M., J.M.G., F.M.E., S.L.N.), and Nephrology and Hypertension (C.J.W., P.C.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Liu Yang
- From the Departments of Radiology (M.Y., K.J.G., A.M., R.L.E.) and Physiology and Biomedical Engineering (A.M.) and the Divisions of Anatomic Pathology (T.M.), Gastroenterology and Hepatology (H.M., D.A.S., R.W., L.Y., V.H.S.), Transplantation Surgery (S.A.M., J.M.G., F.M.E., S.L.N.), and Nephrology and Hypertension (C.J.W., P.C.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Shennen A Mao
- From the Departments of Radiology (M.Y., K.J.G., A.M., R.L.E.) and Physiology and Biomedical Engineering (A.M.) and the Divisions of Anatomic Pathology (T.M.), Gastroenterology and Hepatology (H.M., D.A.S., R.W., L.Y., V.H.S.), Transplantation Surgery (S.A.M., J.M.G., F.M.E., S.L.N.), and Nephrology and Hypertension (C.J.W., P.C.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Jaime M Glorioso
- From the Departments of Radiology (M.Y., K.J.G., A.M., R.L.E.) and Physiology and Biomedical Engineering (A.M.) and the Divisions of Anatomic Pathology (T.M.), Gastroenterology and Hepatology (H.M., D.A.S., R.W., L.Y., V.H.S.), Transplantation Surgery (S.A.M., J.M.G., F.M.E., S.L.N.), and Nephrology and Hypertension (C.J.W., P.C.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Faysal M Elgilani
- From the Departments of Radiology (M.Y., K.J.G., A.M., R.L.E.) and Physiology and Biomedical Engineering (A.M.) and the Divisions of Anatomic Pathology (T.M.), Gastroenterology and Hepatology (H.M., D.A.S., R.W., L.Y., V.H.S.), Transplantation Surgery (S.A.M., J.M.G., F.M.E., S.L.N.), and Nephrology and Hypertension (C.J.W., P.C.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Christopher J Ward
- From the Departments of Radiology (M.Y., K.J.G., A.M., R.L.E.) and Physiology and Biomedical Engineering (A.M.) and the Divisions of Anatomic Pathology (T.M.), Gastroenterology and Hepatology (H.M., D.A.S., R.W., L.Y., V.H.S.), Transplantation Surgery (S.A.M., J.M.G., F.M.E., S.L.N.), and Nephrology and Hypertension (C.J.W., P.C.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Peter C Harris
- From the Departments of Radiology (M.Y., K.J.G., A.M., R.L.E.) and Physiology and Biomedical Engineering (A.M.) and the Divisions of Anatomic Pathology (T.M.), Gastroenterology and Hepatology (H.M., D.A.S., R.W., L.Y., V.H.S.), Transplantation Surgery (S.A.M., J.M.G., F.M.E., S.L.N.), and Nephrology and Hypertension (C.J.W., P.C.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Scott L Nyberg
- From the Departments of Radiology (M.Y., K.J.G., A.M., R.L.E.) and Physiology and Biomedical Engineering (A.M.) and the Divisions of Anatomic Pathology (T.M.), Gastroenterology and Hepatology (H.M., D.A.S., R.W., L.Y., V.H.S.), Transplantation Surgery (S.A.M., J.M.G., F.M.E., S.L.N.), and Nephrology and Hypertension (C.J.W., P.C.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Vijay H Shah
- From the Departments of Radiology (M.Y., K.J.G., A.M., R.L.E.) and Physiology and Biomedical Engineering (A.M.) and the Divisions of Anatomic Pathology (T.M.), Gastroenterology and Hepatology (H.M., D.A.S., R.W., L.Y., V.H.S.), Transplantation Surgery (S.A.M., J.M.G., F.M.E., S.L.N.), and Nephrology and Hypertension (C.J.W., P.C.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Richard L Ehman
- From the Departments of Radiology (M.Y., K.J.G., A.M., R.L.E.) and Physiology and Biomedical Engineering (A.M.) and the Divisions of Anatomic Pathology (T.M.), Gastroenterology and Hepatology (H.M., D.A.S., R.W., L.Y., V.H.S.), Transplantation Surgery (S.A.M., J.M.G., F.M.E., S.L.N.), and Nephrology and Hypertension (C.J.W., P.C.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
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Müller A, Hochrath K, Stroeder J, Hittatiya K, Schneider G, Lammert F, Buecker A, Fries P. Effects of Liver Fibrosis Progression on Tissue Relaxation Times in Different Mouse Models Assessed by Ultrahigh Field Magnetic Resonance Imaging. BIOMED RESEARCH INTERNATIONAL 2017; 2017:8720367. [PMID: 28194423 PMCID: PMC5286538 DOI: 10.1155/2017/8720367] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 12/14/2016] [Indexed: 01/06/2023]
Abstract
Recently, clinical studies demonstrated that magnetic resonance relaxometry with determination of relaxation times T1 and T2⁎ may aid in staging and management of liver fibrosis in patients suffering from viral hepatitis and steatohepatitis. In the present study we investigated T1 and T2⁎ in different models of liver fibrosis to compare alternate pathophysiologies in their effects on relaxation times and to further develop noninvasive quantification methods of liver fibrosis. MRI was performed with a fast spin echo sequence for measurement of T1 and a multigradient echo sequence for determination of T2⁎. Toxic liver fibrosis was induced by injections of carbon tetrachloride (1.4 mL CCl4 per kg bodyweight and week, for 3 or 6 weeks) in BALB/cJ mice. Chronic sclerosing cholangitis was mimicked using the ATP-binding cassette transporter B4 knockout (Abcb4 -/-) mouse model. Untreated BALB/cJ mice served as controls. To assess hepatic fibrosis, we ascertained collagen contents and fibrosis scores after Sirius red staining. T1 and T2⁎ correlate differently to disease severity and etiology of liver fibrosis. T2⁎ shows significant decrease correlating with fibrosis in CCl4 treated animals, while demonstrating significant increase with disease severity in Abcb4 -/- mice. Measurements of T1 and T2⁎ may therefore facilitate discrimination between different stages and causes of liver fibrosis.
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Affiliation(s)
- Andreas Müller
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Str. 100, Bdg. 50.1, 66421 Homburg, Germany
| | - Katrin Hochrath
- Department of Medicine, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA
- Department of Internal Medicine II, Saarland University, Saarland University Medical Center, Bdg. 77, Kirrberger Str. 100, 66421 Homburg, Germany
| | - Jonas Stroeder
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Str. 100, Bdg. 50.1, 66421 Homburg, Germany
| | - Kanishka Hittatiya
- Institute of Pathology, University Hospital Bonn, Bdg. 62, Sigmund-Freud Str. 25, 53127 Bonn, Germany
| | - Günther Schneider
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Str. 100, Bdg. 50.1, 66421 Homburg, Germany
| | - Frank Lammert
- Department of Internal Medicine II, Saarland University, Saarland University Medical Center, Bdg. 77, Kirrberger Str. 100, 66421 Homburg, Germany
| | - Arno Buecker
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Str. 100, Bdg. 50.1, 66421 Homburg, Germany
| | - Peter Fries
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Str. 100, Bdg. 50.1, 66421 Homburg, Germany
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31
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Elgilani F, Mao SA, Glorioso JM, Yin M, Iankov ID, Singh A, Amiot B, Rinaldo P, Marler RJ, Ehman RL, Grompe M, Lillegard JB, Hickey RD, Nyberg SL. Chronic Phenotype Characterization of a Large-Animal Model of Hereditary Tyrosinemia Type 1. THE AMERICAN JOURNAL OF PATHOLOGY 2016; 187:33-41. [PMID: 27855279 DOI: 10.1016/j.ajpath.2016.09.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 09/08/2016] [Accepted: 09/15/2016] [Indexed: 01/06/2023]
Abstract
Hereditary tyrosinemia type 1 (HT1) is an autosomal recessive disease caused by deficiency in fumarylacetoacetate hydrolase, the last enzyme in the tyrosine catabolic pathway. In this study, we investigated whether fumarylacetoacetate hydrolase deficient (FAH-/-) pigs, a novel large-animal model of HT1, develop fibrosis and cirrhosis characteristic of the human disease. FAH-/- pigs were treated with the protective drug 2-(2-nitro-4-trifluoromethylbenzoyl)-1, 3 cyclohexandione (NTBC) at a dose of 1 mg/kg per day initially after birth. After 30 days, they were assigned to one of three groups based on dosing of NTBC. Group 1 received ≥0.2 mg/kg per day, group 2 cycled on/off NTBC (0.05 mg/kg per day × 1 week/0 mg/kg per day × 3 weeks), and group 3 received no NTBC thereafter. Pigs were monitored for features of liver disease. Animals in group 1 continued to have weight gain and biochemical analyses comparable to wild-type pigs. Animals in group 2 had significant cessation of weight gain, abnormal biochemical test results, and various grades of fibrosis and cirrhosis. No evidence of hepatocellular carcinoma was detected. Group 3 animals declined rapidly, with acute liver failure. In conclusion, the FAH-/- pig is a large-animal model of HT1 with clinical characteristics that resemble the human phenotype. Under conditions of low-dose NTBC, FAH-/- pigs developed liver fibrosis and portal hypertension, and thus may serve as a large-animal model of chronic liver disease.
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Affiliation(s)
- Faysal Elgilani
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota
| | - Shennen A Mao
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Meng Yin
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Ianko D Iankov
- Division of Laboratory Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Anisha Singh
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Bruce Amiot
- Brami Biomedical, Inc., Minneapolis, Minnesota
| | - Piero Rinaldo
- Division of Laboratory Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Ronald J Marler
- Department of Comparative Medicine, Mayo Clinic, Scottsdale, Arizona
| | | | - Markus Grompe
- Papé Family Pediatric Research Institute, Oregon Health and Science University, Portland, Oregon
| | - Joseph B Lillegard
- Department of Surgery, Mayo Clinic, Rochester, Minnesota; Midwest Fetal Care Center, Children's Hospital and Clinics of Minnesota, Minneapolis, Minnesota
| | - Raymond D Hickey
- Department of Surgery, Mayo Clinic, Rochester, Minnesota; Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Scott L Nyberg
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota; Department of Surgery, Mayo Clinic, Rochester, Minnesota.
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32
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Tzschätzsch H, Nguyen Trong M, Scheuermann T, Ipek-Ugay S, Fischer T, Schultz M, Braun J, Sack I. Two-Dimensional Time-Harmonic Elastography of the Human Liver and Spleen. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2562-2571. [PMID: 27567061 DOI: 10.1016/j.ultrasmedbio.2016.07.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 07/01/2016] [Accepted: 07/02/2016] [Indexed: 06/06/2023]
Abstract
Measurement of shear wave speed of the liver and spleen by elastography is an established diagnostic procedure for the detection of hepatic fibrosis, portal hypertension and esophageal varices. However, current elastography systems are limited by the size and penetration depth of elastographic windows. In this study, 2D time-harmonic elastography is proposed for generating full field-of-view shear wave speed maps in great depth. Two-dimensional time-harmonic elastography uses external harmonic stimulation at multiple frequencies to create compound shear wave speed maps. The method is tested in a phantom with soft and stiff inclusions and used for elastography of the liver and spleen in 13 asymptomatic volunteers. Each volunteer was scanned twice to determine the sensitivity of the method to physiologic variations: first, after 2 h of fasting, and a second time, 15 min after drinking 1 L of water. The wave speed maps of the phantom clearly identified the soft and stiff inclusions, yielding values that were consistent with those from magnetic resonance elastography. In vivo wave speed values were 1.49 ± 0.11 m/s for the liver and 2.03 ± 0.15 m/s for the spleen in a lower-frequency band centered at 40 Hz and 3.15 ± 0.30 m/s for the spleen in a higher-frequency band centered at 120 Hz. After water intake, wave speed values increased by 6% in the liver (p = 0.002) and decreased in the spleen by 4% (p = 0.021, low-frequency band) and 6% (p = 0.0002, high-frequency band), suggesting the high sensitivity of the method to altered blood flow and perfusion pressure. Two-dimensional time-harmonic elastography of the liver and spleen is a promising method for measuring tissue stiffness at different states of blood flow and perfusion in a large tissue window and at great penetration depth.
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Affiliation(s)
- Heiko Tzschätzsch
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Tobias Scheuermann
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Selcan Ipek-Ugay
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Fischer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Jürgen Braun
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ingolf Sack
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Payen T, Palermo CF, Sastra SA, Chen H, Han Y, Olive KP, Konofagou EE. Elasticity mapping of murine abdominal organs in vivo using harmonic motion imaging (HMI). Phys Med Biol 2016; 61:5741-54. [PMID: 27401609 PMCID: PMC5048218 DOI: 10.1088/0031-9155/61/15/5741] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Recently, ultrasonic imaging of soft tissue mechanics has been increasingly studied to image otherwise undetectable pathologies. However, many underlying mechanisms of tissue stiffening remain unknown, requiring small animal studies and adapted elasticity mapping techniques. Harmonic motion imaging (HMI) assesses tissue viscoelasticity by inducing localized oscillation from a periodic acoustic radiation force. The objective of this study was to evaluate the feasibility of HMI for in vivo elasticity mapping of abdominal organs in small animals. Pathological cases, i.e. chronic pancreatitis and pancreatic cancer, were also studied in vivo to assess the capability of HMI for detection of the change in mechanical properties. A 4.5 MHz focused ultrasound transducer (FUS) generated an amplitude-modulated beam resulting in 50 Hz harmonic tissue oscillations at its focus. Axial tissue displacement was estimated using 1D-cross-correlation of RF signals acquired with a 7.8 MHz diagnostic transducer confocally aligned with the FUS. In vitro results in canine liver and kidney showed the correlation between HMI displacement and Young's moduli measured by rheometry compression testing. HMI was capable of providing reproducible elasticity maps of the mouse abdominal region in vivo allowing the identification of, from stiffest to softest, the murine kidney, pancreas, liver, and spleen. Finally, pancreata affected by pancreatitis and pancreatic cancer showed HMI displacements 1.7 and 2.2 times lower than in the control case, respectively, indicating higher stiffness. The HMI displacement amplitude was correlated with the extent of fibrosis as well as detecting the very onset of stiffening even before fibrosis could be detected on H&E. This work shows that HMI can produce reliable elasticity maps of mouse abdominal region in vivo, thus providing a potentially critical tool to assess pathologies affecting organ elasticity.
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Affiliation(s)
- Thomas Payen
- Biomedical Engineering, Columbia University, USA
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Shiroishi MS, Cen SY, Tamrazi B, D'Amore F, Lerner A, King KS, Kim PE, Law M, Hwang DH, Boyko OB, Liu CSJ. Predicting Meningioma Consistency on Preoperative Neuroimaging Studies. Neurosurg Clin N Am 2016; 27:145-54. [PMID: 27012379 DOI: 10.1016/j.nec.2015.11.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This article provides an overview of the neuroimaging literature focused on preoperative prediction of meningioma consistency. A validated, noninvasive neuroimaging method to predict tumor consistency can provide valuable information regarding neurosurgical planning and patient counseling. Most of the neuroimaging literature indicates conventional MRI using T2-weighted imaging may be helpful to predict meningioma consistency; however, further rigorous validation is necessary. Much less is known about advanced MRI techniques, such as diffusion MRI, MR elastography (MRE), and MR spectroscopy. Of these methods, MRE and diffusion tensor imaging appear particularly promising.
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Affiliation(s)
- Mark S Shiroishi
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
| | - Steven Y Cen
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Benita Tamrazi
- Pediatric Neuroradiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA
| | - Francesco D'Amore
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Alexander Lerner
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Kevin S King
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Paul E Kim
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Meng Law
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Darryl H Hwang
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Orest B Boyko
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Chia-Shang J Liu
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
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Pepin KM, Ehman RL, McGee KP. Magnetic resonance elastography (MRE) in cancer: Technique, analysis, and applications. PROGRESS IN NUCLEAR MAGNETIC RESONANCE SPECTROSCOPY 2015; 90-91:32-48. [PMID: 26592944 PMCID: PMC4660259 DOI: 10.1016/j.pnmrs.2015.06.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/15/2015] [Accepted: 06/16/2015] [Indexed: 05/07/2023]
Abstract
Tissue mechanical properties are significantly altered with the development of cancer. Magnetic resonance elastography (MRE) is a noninvasive technique capable of quantifying tissue mechanical properties in vivo. This review describes the basic principles of MRE and introduces some of the many promising MRE methods that have been developed for the detection and characterization of cancer, evaluation of response to therapy, and investigation of the underlying mechanical mechanisms associated with malignancy.
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Liu Y, Fite BZ, Mahakian LM, Johnson SM, Larrat B, Dumont E, Ferrara KW. Concurrent Visualization of Acoustic Radiation Force Displacement and Shear Wave Propagation with 7T MRI. PLoS One 2015; 10:e0139667. [PMID: 26439259 PMCID: PMC4594908 DOI: 10.1371/journal.pone.0139667] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 09/16/2015] [Indexed: 01/21/2023] Open
Abstract
Manual palpation is a common and very informative diagnostic tool based on estimation of changes in the stiffness of tissues that result from pathology. In the case of a small lesion or a lesion that is located deep within the body, it is difficult for changes in mechanical properties of tissue to be detected or evaluated via palpation. Furthermore, palpation is non-quantitative and cannot be used to localize the lesion. Magnetic Resonance-guided Focused Ultrasound (MRgFUS) can also be used to evaluate the properties of biological tissues non-invasively. In this study, an MRgFUS system combines high field (7T) MR and 3 MHz focused ultrasound to provide high resolution MR imaging and a small ultrasonic interrogation region (~0.5 x 0.5 x 2 mm), as compared with current clinical systems. MR-Acoustic Radiation Force Imaging (MR-ARFI) provides a reliable and efficient method for beam localization by detecting micron-scale displacements induced by ultrasound mechanical forces. The first aim of this study is to develop a sequence that can concurrently quantify acoustic radiation force displacements and image the resulting transient shear wave. Our motivation in combining these two measurements is to develop a technique that can rapidly provide both ARFI and shear wave velocity estimation data, making it suitable for use in interventional radiology. Secondly, we validate this sequence in vivo by estimating the displacement before and after high intensity focused ultrasound (HIFU) ablation, and we validate the shear wave velocity in vitro using tissue-mimicking gelatin and tofu phantoms. Such rapid acquisitions are especially useful in interventional radiology applications where minimizing scan time is highly desirable.
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Affiliation(s)
- Yu Liu
- Department of Biomedical Engineering, University of California Davis, Davis, CA, 95616, United States of America
| | - Brett Z. Fite
- Department of Biomedical Engineering, University of California Davis, Davis, CA, 95616, United States of America
| | - Lisa M. Mahakian
- Department of Biomedical Engineering, University of California Davis, Davis, CA, 95616, United States of America
| | - Sarah M. Johnson
- Department of Biomedical Engineering, University of California Davis, Davis, CA, 95616, United States of America
| | - Benoit Larrat
- UNité d’Imagerie par Résonance Magnétique et Spectroscopie, NeuroSpin, CEA, Gif Sur Yvette, France
| | | | - Katherine W. Ferrara
- Department of Biomedical Engineering, University of California Davis, Davis, CA, 95616, United States of America
- * E-mail:
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Zou LQ, Chen J, Pan L, Jiang JZ, Xing W. Comparison of magnetic resonance elastography and diffusion-weighted imaging for staging hepatic fibrosis. Chin Med J (Engl) 2015; 128:620-5. [PMID: 25698193 PMCID: PMC4834772 DOI: 10.4103/0366-6999.151659] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: To compare the diagnostic values of magnetic resonance elastography (MRE) and diffusion-weighted imaging (DWI) in staging hepatic fibrosis (HF) in an animal model. Methods: This study consisted of 44 rabbits served as HF group and 9 normal rabbits. HF group was divided into two subgroups: Group A (n = 32) and Group B (n = 12). Rabbits in Group B were served as a complementary group when rabbits in Group A suddenly died during the study. Rabbits from control and Group A underwent abdominal MR imaging (MRI), MRE, and DWI. In Group A, random eight rabbits underwent MRI examinations at 4, 5, 6, 10 weeks after carbon tetrachloride oil subcutaneous injection. Liver stiffness (LS) and apparent diffusion coefficient (ADC) values of liver parenchyma were measured. The diagnostic performance of MRE and DWI for staging HF was compared using the receiver operating characteristic curve analysis on the basis of the histopathological analysis of HF. Results: Significant differences of LS and DWI values were present among HF stages (P < 0.005). The LS values measured on MRE (r = 0.838, P < 0.001) were more strongly correlated with the HF stages than with ADC values (r = −0.527, P < 0.001). The area under the receiver operating characteristic curve values of LS were significantly larger than those of DWI were for discriminating two stages of HF (0.979 vs. 0.712 for ≥ S1, 0.922 vs. 0.699 for ≥ S2). MRE showed higher specificity for predicting all stages of HF compared to DWI. Conclusions: MRE more strongly correlated with the HF stages than DWI and is more specific in predicting all HF stages.
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Affiliation(s)
| | | | | | | | - Wei Xing
- Department of Radiology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu 213003, China
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Natarajan V, Berglund EJ, Chen DX, Kidambi S. Substrate stiffness regulates primary hepatocyte functions. RSC Adv 2015; 5:80956-80966. [PMID: 32733675 PMCID: PMC7392243 DOI: 10.1039/c5ra15208a] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Liver fibrosis occurs as a consequence of chronic injuries from viral infections, metabolic disorders, and alcohol abuse. Fibrotic liver microenvironment (LME) is characterized by excessive deposition and aberrant turnover of extracellular matrix proteins, which leads to increased tissue stiffness. Liver stiffness acts as a vital cue in the regulation of hepatic responses in both healthy and diseased states; however, the effect of varying stiffness on liver cells is not well understood. There is a critical need to engineer in vitro models that mimic the liver stiffness corresponding to various stages of disease progression in order to elucidate the role of individual cellular responses. Here we employed polydimethyl siloxane (PDMS) based substrates with tunable mechanical properties to investigate the effect of substrate stiffness on the behavior of primary rat hepatocytes. To recreate physiologically relevant stiffness, we designed soft substrates (2 kPa) to represent the healthy liver and stiff substrates (55 kPa) to represent the diseased liver. Tissue culture plate surface (TCPS) served as the control substrate. We observed that hepatocytes cultured on soft substrates displayed a more differentiated and functional phenotype for a longer duration as compared to stiff substrates and TCPS. We demonstrated that hepatocytes on soft substrates exhibited higher urea and albumin synthesis. Cytochrome P450 (CYP) activity, another critical marker of hepatocytes, displayed a strong dependence on substrate stiffness, wherein hepatocytes on soft substrates retained 2.7 fold higher CYP activity on day 7 in culture, as compared to TCPS. We further observed that an increase in stiffness induced downregulation of key drug transporter genes (NTCP, UGT1A1, and GSTM-2). In addition, we observed that the epithelial cell phenotype was better maintained on soft substrates as indicated by higher expression of hepatocyte nuclear factor 4α, cytokeratin 18, and connexin 32. These results indicate that the substrate stiffness plays a significant role in modulating hepatocyte behavior. Our PDMS based liver model can be utilized to investigate the signaling pathways mediating the hepatocyte-LME communication to understand the progression of liver diseases.
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Affiliation(s)
- Vaishaali Natarajan
- Department of Chemical and Biomolecular Engineering, University of Nebraska-Lincoln, NE, 68588, USA
| | - Eric J Berglund
- Department of Chemical and Biomolecular Engineering, University of Nebraska-Lincoln, NE, 68588, USA
| | - Dorothy X Chen
- Department of Chemical and Biomolecular Engineering, University of Nebraska-Lincoln, NE, 68588, USA
| | - Srivatsan Kidambi
- Department of Chemical and Biomolecular Engineering, University of Nebraska-Lincoln, NE, 68588, USA
- Nebraska Center for Materials and Nanoscience, University of Nebraska-Lincoln, NE, 68588, USA
- Mary and Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, NE, 68198, USA
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Masi B, Perles-Barbacaru TA, Laprie C, Dessein H, Bernard M, Dessein A, Viola A. In Vivo MRI Assessment of Hepatic and Splenic Disease in a Murine Model of Schistosomiasis [corrected]. PLoS Negl Trop Dis 2015; 9:e0004036. [PMID: 26394390 PMCID: PMC4578925 DOI: 10.1371/journal.pntd.0004036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 08/04/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Schistosomiasis (or bilharzia), a major parasitic disease, affects more than 260 million people worldwide. In chronic cases of intestinal schistosomiasis caused by trematodes of the Schistosoma genus, hepatic fibrosis develops as a host immune response to the helminth eggs, followed by potentially lethal portal hypertension. In this study, we characterized hepatic and splenic features of a murine model of intestinal schistosomiasis using in vivo magnetic resonance imaging (MRI) and evaluated the transverse relaxation time T2 as a non-invasive imaging biomarker for monitoring hepatic fibrogenesis. METHODOLOGY/PRINCIPAL FINDINGS CBA/J mice were imaged at 11.75 T two, six and ten weeks after percutaneous infection with Schistosoma mansoni. In vivo imaging studies were completed with histology at the last two time points. Anatomical MRI allowed detection of typical manifestations of the intestinal disease such as significant hepato- and splenomegaly, and dilation of the portal vein as early as six weeks, with further aggravation at 10 weeks after infection. Liver multifocal lesions observed by MRI in infected animals at 10 weeks post infection corresponded to granulomatous inflammation and intergranulomatous fibrosis with METAVIR scores up to A2F2. While most healthy hepatic tissue showed T2 values below 14 ms, these lesions were characterized by a T2 greater than 16 ms. The area fraction of increased T2 correlated (rS = 0.83) with the area fraction of Sirius Red stained collagen in histological sections. A continuous liver T2* decrease was also measured while brown pigments in macrophages were detected at histology. These findings suggest accumulation of hematin in infected livers. CONCLUSIONS/SIGNIFICANCE Our multiparametric MRI approach confirms that this murine model replicates hepatic and splenic manifestations of human intestinal schistosomiasis. Quantitative T2 mapping proved sensitive to assess liver fibrogenesis non-invasively and may therefore constitute an objective imaging biomarker for treatment monitoring in diseases involving hepatic fibrosis.
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Affiliation(s)
- Brice Masi
- Génétique et Immunologie des Maladies Parasitaires-Unité Mixte de Recherche S_906, Aix-Marseille Université, Marseille, France
- Unité 906, Institut National de la Santé et de la Recherche Médicale, Marseille, France
| | - Teodora-Adriana Perles-Barbacaru
- Centre de Résonance Magnétique Biologique et Médicale-Unité Mixte de Recherche 7339, Aix-Marseille Université, Marseille, France
- Unité Mixte de Recherche 7339, Centre National de la Recherche Scientifique, Marseille, France
| | | | - Helia Dessein
- Génétique et Immunologie des Maladies Parasitaires-Unité Mixte de Recherche S_906, Aix-Marseille Université, Marseille, France
- Unité 906, Institut National de la Santé et de la Recherche Médicale, Marseille, France
| | - Monique Bernard
- Centre de Résonance Magnétique Biologique et Médicale-Unité Mixte de Recherche 7339, Aix-Marseille Université, Marseille, France
- Unité Mixte de Recherche 7339, Centre National de la Recherche Scientifique, Marseille, France
| | - Alain Dessein
- Génétique et Immunologie des Maladies Parasitaires-Unité Mixte de Recherche S_906, Aix-Marseille Université, Marseille, France
- Unité 906, Institut National de la Santé et de la Recherche Médicale, Marseille, France
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Angèle Viola
- Centre de Résonance Magnétique Biologique et Médicale-Unité Mixte de Recherche 7339, Aix-Marseille Université, Marseille, France
- Unité Mixte de Recherche 7339, Centre National de la Recherche Scientifique, Marseille, France
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Connesson N, Clayton E, Bayly P, Pierron F. Extension of the Optimized Virtual Fields Method to estimate viscoelastic material parameters from 3D dynamic displacement fields. STRAIN 2015; 51:110-134. [PMID: 26146416 PMCID: PMC4486339 DOI: 10.1111/str.12126] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
In-vivo measurement of the mechanical properties of soft tissues is essential to provide necessary data in biomechanics and medicine (early cancer diagnosis, study of traumatic brain injuries, etc.). Imaging techniques such as Magnetic Resonance Elastography (MRE) can provide 3D displacement maps in the bulk and in vivo, from which, using inverse methods, it is then possible to identify some mechanical parameters of the tissues (stiffness, damping etc.). The main difficulties in these inverse identification procedures consist in dealing with the pressure waves contained in the data and with the experimental noise perturbing the spatial derivatives required during the processing. The Optimized Virtual Fields Method (OVFM) [1], designed to be robust to noise, present natural and rigorous solution to deal with these problems. The OVFM has been adapted to identify material parameter maps from Magnetic Resonance Elastography (MRE) data consisting of 3-dimensional displacement fields in harmonically loaded soft materials. In this work, the method has been developed to identify elastic and viscoelastic models. The OVFM sensitivity to spatial resolution and to noise has been studied by analyzing 3D analytically simulated displacement data. This study evaluates and describes the OVFM identification performances: different biases on the identified parameters are induced by the spatial resolution and experimental noise. The well-known identification problems in the case of quasi-incompressible materials also find a natural solution in the OVFM. Moreover, an a posteriori criterion to estimate the local identification quality is proposed. The identification results obtained on actual experiments are briefly presented.
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Affiliation(s)
- N. Connesson
- Laboratoire TIMC-IMAG, Université de Grenoble (INPG-UJF), BP 53, 38041 Grenoble Cedex 9, France
| | - E.H. Clayton
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, One Brookings Drive, Campus Box 1185, St. Louis, Missouri 63130, USA
| | - P.V. Bayly
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, One Brookings Drive, Campus Box 1185, St. Louis, Missouri 63130, USA
| | - F. Pierron
- Engineering and the Environment, University of Southampton, Highfield, Southampton SO17 1BJ, UK
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Song P, Macdonald MC, Behler RH, Lanning JD, Wang MH, Urban MW, Manduca A, Zhao H, Callstrom MR, Alizad A, Greenleaf JF, Chen S. Two-dimensional shear-wave elastography on conventional ultrasound scanners with time-aligned sequential tracking (TAST) and comb-push ultrasound shear elastography (CUSE). IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2015; 62:290-302. [PMID: 25643079 PMCID: PMC4315508 DOI: 10.1109/tuffc.2014.006628] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Two-dimensional shear-wave elastography presents 2-D quantitative shear elasticity maps of tissue, which are clinically useful for both focal lesion detection and diffuse disease diagnosis. Realization of 2-D shear-wave elastography on conventional ultrasound scanners, however, is challenging because of the low tracking pulse-repetition-frequency (PRF) of these systems. Although some clinical and research platforms support software beamforming and plane-wave imaging with high PRF, the majority of current clinical ultrasound systems do not have the software beamforming capability, which presents a critical challenge for translating the 2-D shear-wave elastography technique from laboratory to clinical scanners. To address this challenge, this paper presents a time-aligned sequential tracking (TAST) method for shear-wave tracking on conventional ultrasound scanners. TAST takes advantage of the parallel beamforming capability of conventional systems and realizes high-PRF shear-wave tracking by sequentially firing tracking vectors and aligning shear wave data in the temporal direction. The comb-push ultrasound shear elastography (CUSE) technique was used to simultaneously produce multiple shear wave sources within the field-of-view (FOV) to enhance shear wave SNR and facilitate robust reconstructions of 2-D elasticity maps. TAST and CUSE were realized on a conventional ultrasound scanner. A phantom study showed that the shear-wave speed measurements from the conventional ultrasound scanner were in good agreement with the values measured from other 2-D shear wave imaging technologies. An inclusion phantom study showed that the conventional ultrasound scanner had comparable performance to a state-of-the-art shear-wave imaging system in terms of bias and precision in measuring different sized inclusions. Finally, in vivo case analysis of a breast with a malignant mass, and a liver from a healthy subject demonstrated the feasibility of using the conventional ultrasound scanner for in vivo 2-D shear-wave elastography. These promising results indicate that the proposed technique can enable the implementation of 2-D shear-wave elastography on conventional ultrasound scanners and potentially facilitate wider clinical applications with shear-wave elastography.
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Affiliation(s)
- Pengfei Song
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN
| | | | | | | | | | - Matthew W. Urban
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN
| | - Armando Manduca
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN
| | - Heng Zhao
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN
| | | | - Azra Alizad
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN
- Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - James F. Greenleaf
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN
| | - Shigao Chen
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, MN
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De Robertis R, D’Onofrio M, Demozzi E, Crosara S, Canestrini S, Pozzi Mucelli R. Noninvasive diagnosis of cirrhosis: A review of different imaging modalities. World J Gastroenterol 2014; 20:7231-7241. [PMID: 24966594 PMCID: PMC4064069 DOI: 10.3748/wjg.v20.i23.7231] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 01/08/2014] [Accepted: 04/09/2014] [Indexed: 02/06/2023] Open
Abstract
Progressive hepatic fibrosis can lead to cirrhosis, so its early detection is fundamental. Staging fibrosis is also critical for prognosis and management. The gold standard for these aims is liver biopsy, but it has several drawbacks, as it is invasive, expensive, has poor acceptance, is prone to inter observer variability and sampling errors, has poor repeatability, and has a risk of complications and mortality. Therefore, non-invasive imaging tests have been developed. This review mainly focuses on the role of transient elastography, acoustic radiation force impulse imaging, and magnetic resonance-based methods for the noninvasive diagnosis of cirrhosis.
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43
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Ronot M, Lambert SA, Wagner M, Garteiser P, Doblas S, Albuquerque M, Paradis V, Vilgrain V, Sinkus R, Van Beers BE. Viscoelastic parameters for quantifying liver fibrosis: three-dimensional multifrequency MR elastography study on thin liver rat slices. PLoS One 2014; 9:e94679. [PMID: 24722733 PMCID: PMC3983230 DOI: 10.1371/journal.pone.0094679] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 03/19/2014] [Indexed: 01/22/2023] Open
Abstract
Objective To assess in a high-resolution model of thin liver rat slices which viscoelastic parameter at three-dimensional multifrequency MR elastography has the best diagnostic performance for quantifying liver fibrosis. Materials and Methods The study was approved by the ethics committee for animal care of our institution. Eight normal rats and 42 rats with carbon tetrachloride induced liver fibrosis were used in the study. The rats were sacrificed, their livers were resected and three-dimensional MR elastography of 5±2 mm liver slices was performed at 7T with mechanical frequencies of 500, 600 and 700 Hz. The complex shear, storage and loss moduli, and the coefficient of the frequency power law were calculated. At histopathology, fibrosis and inflammation were assessed with METAVIR score, fibrosis was further quantified with morphometry. The diagnostic value of the viscoelastic parameters for assessing fibrosis severity was evaluated with simple and multiple linear regressions, receiver operating characteristic analysis and Obuchowski measures. Results At simple regression, the shear, storage and loss moduli were associated with the severity of fibrosis. At multiple regression, the storage modulus at 600 Hz was the only parameter associated with fibrosis severity (r = 0.86, p<0.0001). This parameter had an Obuchowski measure of 0.89+/−0.03. This measure was significantly larger than that of the loss modulus (0.78+/−0.04, p = 0.028), but not than that of the complex shear modulus (0.88+/−0.03, p = 0.84). Conclusion Our high resolution, three-dimensional multifrequency MR elastography study of thin liver slices shows that the storage modulus is the viscoelastic parameter that has the best association with the severity of liver fibrosis. However, its diagnostic performance does not differ significantly from that of the complex shear modulus.
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Affiliation(s)
- Maxime Ronot
- Department of Radiology, Beaujon University Hospitals Paris Nord Val de Seine, Clichy, France
- University Paris Diderot, Sorbonne Paris Cité, France
- IPMA, INSERM U773, Centre de Recherche Biomédicale Bichat-Beaujon, Paris, France
- * E-mail:
| | - Simon A. Lambert
- University Paris Diderot, Sorbonne Paris Cité, France
- IPMA, INSERM U773, Centre de Recherche Biomédicale Bichat-Beaujon, Paris, France
| | - Mathilde Wagner
- Department of Radiology, Beaujon University Hospitals Paris Nord Val de Seine, Clichy, France
- University Paris Diderot, Sorbonne Paris Cité, France
- IPMA, INSERM U773, Centre de Recherche Biomédicale Bichat-Beaujon, Paris, France
| | - Philippe Garteiser
- University Paris Diderot, Sorbonne Paris Cité, France
- IPMA, INSERM U773, Centre de Recherche Biomédicale Bichat-Beaujon, Paris, France
| | - Sabrina Doblas
- University Paris Diderot, Sorbonne Paris Cité, France
- IPMA, INSERM U773, Centre de Recherche Biomédicale Bichat-Beaujon, Paris, France
| | - Miguel Albuquerque
- IPMA, INSERM U773, Centre de Recherche Biomédicale Bichat-Beaujon, Paris, France
- Department of Pathology, Beaujon University Hospitals Paris Nord Val de Seine, Clichy, France
| | - Valérie Paradis
- University Paris Diderot, Sorbonne Paris Cité, France
- IPMA, INSERM U773, Centre de Recherche Biomédicale Bichat-Beaujon, Paris, France
- Department of Pathology, Beaujon University Hospitals Paris Nord Val de Seine, Clichy, France
| | - Valérie Vilgrain
- Department of Radiology, Beaujon University Hospitals Paris Nord Val de Seine, Clichy, France
- University Paris Diderot, Sorbonne Paris Cité, France
- IPMA, INSERM U773, Centre de Recherche Biomédicale Bichat-Beaujon, Paris, France
| | - Ralph Sinkus
- University Paris Diderot, Sorbonne Paris Cité, France
- IPMA, INSERM U773, Centre de Recherche Biomédicale Bichat-Beaujon, Paris, France
| | - Bernard E. Van Beers
- Department of Radiology, Beaujon University Hospitals Paris Nord Val de Seine, Clichy, France
- University Paris Diderot, Sorbonne Paris Cité, France
- IPMA, INSERM U773, Centre de Recherche Biomédicale Bichat-Beaujon, Paris, France
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Czaja AJ. Review article: The prevention and reversal of hepatic fibrosis in autoimmune hepatitis. Aliment Pharmacol Ther 2014; 39:385-406. [PMID: 24387318 DOI: 10.1111/apt.12592] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 11/29/2013] [Accepted: 12/05/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Immunosuppressive treatment of autoimmune hepatitis can prevent or reverse hepatic fibrosis, but these anti-fibrotic effects are inconsistent secondary gains. AIM To describe the anti-fibrotic effects of current therapies for autoimmune hepatitis, discuss the pathogenic mechanisms of hepatic fibrosis that might be targeted by anti-fibrotic interventions, indicate the non-invasive diagnostic tests of hepatic fibrosis that must be validated in autoimmune hepatitis and to suggest promising treatment opportunities. METHODS Studies cited in PubMed from 1972 to 2013 for autoimmune hepatitis, hepatic fibrosis, cirrhosis, anti-fibrotic therapy and non-invasive tests of hepatic fibrosis were selected. RESULTS Hepatic fibrosis improves in 53-57% of corticosteroid-treated patients with autoimmune hepatitis; progressive fibrosis slows or is prevented in 79%; and cirrhosis may be reversed. Progressive hepatic fibrosis is associated with liver inflammation, and the inability to fully suppress inflammatory activity within 12 months is associated with progression to cirrhosis (54%) and death or need for liver transplantation (15%). Liver tissue examination remains the gold standard for assessing hepatic fibrosis, but laboratory and radiological tests may be useful non-invasive methods to measure the fibrotic response. Severe liver inflammation can confound radiological assessments, and the preferred non-invasive test in autoimmune hepatitis is uncertain. Individualised treatment adjustments and adjunctive anti-fibrotic therapies are poised for study in this disease. CONCLUSIONS The prevention and reversal of hepatic fibrosis are achievable objectives in autoimmune hepatitis. Strategies that evaluate individualised therapies adjusted to the rapidity and completeness of the inflammatory response, and the use of adjunctive anti-fibrotic interventions, must be evaluated.
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Affiliation(s)
- A J Czaja
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA
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45
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Guvendiren M, Perepelyuk M, Wells RG, Burdick JA. Hydrogels with differential and patterned mechanics to study stiffness-mediated myofibroblastic differentiation of hepatic stellate cells. J Mech Behav Biomed Mater 2013; 38:198-208. [PMID: 24361340 DOI: 10.1016/j.jmbbm.2013.11.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 10/17/2013] [Accepted: 11/13/2013] [Indexed: 02/06/2023]
Abstract
The differentiation of hepatic stellate cells (HSCs) into myofibroblasts is a key event in liver fibrosis. Due to the local stiffening of the extracellular matrix (ECM) during fibrosis, it is of great interest to develop mimics that can be used to investigate the cellular response to changes in mechanics. Here, we used a step-wise hydrogel crosslinking technique, where macromolecules are crosslinked using a sequence of addition then UV light-mediated radical crosslinking, to generate hydrogels with tunable stiffness. Freshly isolated HSCs remained rounded with lipid droplets and high levels of PPARγ expression on soft substrates (E~2kPa); however, HSCs spread, lost their lipid droplets, and expressed high levels of α-smooth muscle actin (α-SMA) and type I collagen on stiff substrates (E~24kPa). Similarly, fully differentiated cells reverted to a quiescent state when plated on soft substrates. Stiffness-induced differentiation of HSCs was enhanced in the presence of exogenous TGF-β1, a dominant signal in fibrosis. When the UV-induced secondary crosslinking was restricted with a photomask to spatially control mechanics, HSCs responded based on the local hydrogel stiffness, although they remained quiescent on stiff substrates if the stiff feature size was not sufficient to allow cell spreading. This hydrogel system permits the investigation of HSC response to materials with diverse levels and spatially heterogeneous mechanical properties.
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Affiliation(s)
- Murat Guvendiren
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Maryna Perepelyuk
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Rebecca G Wells
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Jason A Burdick
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Wallihan DB, Podberesky DJ, Marino BS, Sticka JS, Serai S. Relationship of MR elastography determined liver stiffness with cardiac function after Fontan palliation. J Magn Reson Imaging 2013; 40:1328-35. [PMID: 24408379 DOI: 10.1002/jmri.24496] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 09/28/2013] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To use MR elastography to assess liver stiffness in patients with congenital heart disease palliated with the Fontan procedure and correlate findings with cardiac index and other functional parameters obtained during cardiac MRI. MATERIALS AND METHODS We performed a retrospective study of 14 patients (15 examinations) with Fontan circulation who underwent both cardiac MRI and liver MR elastography (MRE) on the same day. Liver stiffness was determined by calculating the mean liver stiffness from four slice locations. The cardiac index and other flow measurements were calculated from phase contrast MR imaging. RESULTS The MRE was abnormal on all examinations with a median liver stiffness of 4.0 kPa (range, 3.4-6.2 kPa; normal adult liver stiffness is < 2.51 kPa). The cardiac index decreased as the duration of Fontan circulation (Fontan duration) increased (P = 0.005). We found a statistically significant inverse correlation between liver stiffness and cardiac index (P = 0.02), as well as the ejection fraction (P = 0.002). Patients with long Fontan durations (≥ 20 years) had greater liver stiffness compared with those having a shorter duration (P = 0.02). CONCLUSION MRE shows promise as a monitoring tool in the Fontan population, demonstrating an elevated liver stiffness in all patients, which inversely correlated with the MR determined cardiac index.
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Affiliation(s)
- Daniel B Wallihan
- Cincinnati Children's Hospital Medical Center, Department of Radiology, Cincinnati, Ohio, USA
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Chen X, Shen Y, Zheng Y, Lin H, Guo Y, Zhu Y, Zhang X, Wang T, Chen S. Quantification of liver viscoelasticity with acoustic radiation force: a study of hepatic fibrosis in a rat model. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:2091-102. [PMID: 23993170 DOI: 10.1016/j.ultrasmedbio.2013.05.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 05/21/2013] [Accepted: 05/23/2013] [Indexed: 05/19/2023]
Abstract
Ultrasound elastography, based on shear wave propagation, enables the quantitative and non-invasive assessment of liver mechanical properties such as stiffness and has been found to be feasible for and useful in the diagnosis of hepatic fibrosis. Most ultrasound elastographic methods use a purely elastic model to describe liver mechanical properties. However, to describe tissue that is dispersive and to obtain an accurate measure of tissue elasticity, the viscoelasticity of the tissue should be examined. The objective of this study was to investigate the shear viscoelastic characteristics, as measured by ultrasound elastography, of liver fibrosis in a rat model and to evaluate the diagnostic accuracy of viscoelasticity for staging liver fibrosis. Liver fibrosis was induced in 37 rats using carbon tetrachloride (CCl4); 6 rats served as controls. Liver viscoelasticity was measured in vitro using shear waves induced by acoustic radiation force. The measured mean values of liver elasticity and viscosity ranged from 0.84 to 3.45 kPa and from 1.12 to 2.06 Pa·s for fibrosis stages F0-F4, respectively. Spearman correlation coefficients indicated that stage of fibrosis was well correlated with elasticity (0.88) and moderately correlated with viscosity (0.66). The areas under receiver operating characteristic curves were 0.97 (≥F2), 0.91 (≥F3) and 1.00 (F4) for elasticity and 0.91 (≥F2), 0.79 (≥F3) and 0.74 (F4) for viscosity, respectively. The results confirmed that shear wave velocity was dispersive in frequency, suggesting a viscoelastic model to describe liver fibrosis. The study finds that although viscosity is not as good as elasticity for staging fibrosis, it is important to consider viscosity to make an accurate estimation of elasticity; it may also provide other mechanical insights into liver tissues.
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Affiliation(s)
- Xin Chen
- School of Medicine, Shenzhen University, Shenzhen, China; National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Shenzhen, China; Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen, China
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Serai SD, Wallihan DB, Venkatesh SK, Ehman RL, Campbell KM, Sticka J, Marino BS, Podberesky DJ. Magnetic resonance elastography of the liver in patients status-post fontan procedure: feasibility and preliminary results. CONGENIT HEART DIS 2013; 9:7-14. [PMID: 24134059 DOI: 10.1111/chd.12144] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2013] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the feasibility of performing magnetic resonance elastography (MRE) as a screening tool for elevated liver stiffness in patients' status-post Fontan procedure. BACKGROUND With greater numbers of Fontan patients surviving far into adulthood, a factor increasingly affecting long-term prognosis is the presence of hepatic congestion and fibrosis. If detected early, steps can be taken to potentially slow or halt the progression of fibrosis. MRE is a relatively new, noninvasive imaging technique, which can quantitatively measure liver stiffness and provide an estimate of the extent of fibrosis. METHODS A retrospective study was conducted using MRE to evaluate liver stiffness in patients with a history of Fontan procedure. An MRE was performed in the same session as a clinical cardiac MRI. The liver was interrogated at four slice locations, and a mean liver stiffness value was calculated for each patient using postprocessing software. The medical records were reviewed for demographic and clinical characteristics. RESULTS During the time frame of this investigation, 17 MRE exams were performed on 16 patients. All patients had elevated liver stiffness values as defined by MRE standards. The median of the individual mean liver stiffness values was 5.1 kPa (range: 3.4-8.2 kPa). This range of liver stiffness elevation would suggest the presence of mild to severe fibrosis in a patient with standard cardiovascular anatomy. We found a significant trend toward higher liver stiffness values with greater duration of Fontan circulation (rs = 0.55, P = .02). CONCLUSION Our preliminary findings suggest that MRE is a feasible method for evaluating the liver in Fontan patients who are undergoing surveillance cardiac MRI. Further investigation with histologic correlation is needed to determine the contributions of hepatic congestion and fibrosis to the liver stiffness in this population.
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Affiliation(s)
- Suraj D Serai
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Yasar TK, Klatt D, Magin RL, Royston TJ. Selective spectral displacement projection for multifrequency MRE. Phys Med Biol 2013; 58:5771-81. [PMID: 23912182 DOI: 10.1088/0031-9155/58/16/5771] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We introduce a new motion encoding concept for the displacement vector in multifrequency magnetic resonance elastography (MRE). Selective spectral displacement projection (SDP)-MRE can be applied to a vibration spectrum composed of three frequencies and exploits the filter condition of MRE for selecting one frequency each per spatial motion encoding direction. The selected components are simultaneously encoded in the phase of the MR signal. Therefore, the total MR phase is represented by a sum of phase portions, each corresponding to a distinct spatial projection and vibration frequency. The individual components can be obtained by applying a Fourier-transform to the temporally resolved phase images. SDP-MRE reduces the number of temporally resolved MRE experiments for data acquisition by a factor of 3, while providing similar wave images as found using conventional monofrequency MRE.
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Affiliation(s)
- Temel K Yasar
- Department of Mechanical and Industrial Engineering, The University of Illinois at Chicago, Chicago, IL, USA.
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Godfrey EM, Mannelli L, Griffin N, Lomas DJ. Magnetic resonance elastography in the diagnosis of hepatic fibrosis. Semin Ultrasound CT MR 2013; 34:81-8. [PMID: 23395320 DOI: 10.1053/j.sult.2012.11.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Liver fibrosis is a common feature of many chronic liver diseases, and can ultimately progress to cirrhosis. Conventional imaging is insensitive to liver fibrosis, necessitating a liver biopsy for diagnosis and monitoring of progression. However, liver biopsy risks complications, and is an imperfect gold standard in view of sampling error and intraobserver or interobserver variation. Magnetic resonance elastography (MRE) is a noninvasive method for assessing the mechanical properties of tissues and is gaining credence as a method of assessment for hepatic fibrosis. The aim of this review is to describe how MRE is performed, to review the present literature on the subject, to compare MRE with other noninvasive techniques used to assess for liver fibrosis, and to highlight areas of future research.
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Affiliation(s)
- Edmund M Godfrey
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, UK.
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