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Yoon H, Kim J, Lim HJ, Lee MJ. Quantitative Liver Imaging in Children. Invest Radiol 2024:00004424-990000000-00238. [PMID: 39047265 DOI: 10.1097/rli.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
ABSTRACT In children and adults, quantitative imaging examinations determine the effectiveness of treatment for liver disease. However, pediatric liver disease differs in presentation from liver disease in adults. Children also needed to be followed for a longer period from onset and have less control of their bodies, showing more movement than adults during imaging examinations, which leads to a greater need for sedation. Thus, it is essential to appropriately tailor and accurately perform noninvasive imaging tests in these younger patients. This article is an overview of updated imaging techniques used to assess liver disease quantitatively in children. The common initial imaging study for diffuse liver disease in pediatric patients is ultrasound. In addition to preexisting echo analysis, newly developed attenuation imaging techniques have been introduced to evaluate fatty liver. Ultrasound elastography is also now actively used to evaluate liver conditions, and the broad age spectrum of the pediatric population requires caution to be taken even in the selection of probes. Magnetic resonance imaging (MRI) is another important imaging tool used to evaluate liver disease despite requiring sedation or anesthesia in young children because it allows quantitative analysis with sequences such as fat analysis and MR elastography. In addition to ultrasound and MRI, we review quantitative imaging methods specifically for fatty liver, Wilson disease, biliary atresia, hepatic fibrosis, Fontan-associated liver disease, autoimmune hepatitis, sinusoidal obstruction syndrome, and the transplanted liver. Lastly, concerns such as growth and motion that need to be addressed specifically for children are summarized.
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Affiliation(s)
- Haesung Yoon
- From the Department of Radiology, Gangnam Severance Hospital, Seoul, South Korea (H.Y.); Department of Radiology and Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, South Korea (H.Y., J.K., H.J.L., M.-J.L.); and Department of Pediatric Radiology, Severance Children's Hospital, Seoul, South Korea (J.K., H.J.L., M.-J.L.)
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Shih SF, Wu HH. Free-breathing MRI techniques for fat and R 2* quantification in the liver. MAGMA (NEW YORK, N.Y.) 2024:10.1007/s10334-024-01187-2. [PMID: 39039272 DOI: 10.1007/s10334-024-01187-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 05/18/2024] [Accepted: 07/02/2024] [Indexed: 07/24/2024]
Abstract
OBJECTIVE To review the recent advancements in free-breathing MRI techniques for proton-density fat fraction (PDFF) and R2* quantification in the liver, and discuss the current challenges and future opportunities. MATERIALS AND METHODS This work focused on recent developments of different MRI pulse sequences, motion management strategies, and reconstruction approaches that enable free-breathing liver PDFF and R2* quantification. RESULTS Different free-breathing liver PDFF and R2* quantification techniques have been evaluated in various cohorts, including healthy volunteers and patients with liver diseases, both in adults and children. Initial results demonstrate promising performance with respect to reference measurements. These techniques have a high potential impact on providing a solution to the clinical need of accurate liver fat and iron quantification in populations with limited breath-holding capacity. DISCUSSION As these free-breathing techniques progress toward clinical translation, studies of the linearity, bias, and repeatability of free-breathing PDFF and R2* quantification in a larger cohort are important. Scan acceleration and improved motion management also hold potential for further enhancement.
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Affiliation(s)
- Shu-Fu Shih
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA, USA
| | - Holden H Wu
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA.
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA, USA.
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Strobel KM, Kafali SG, Shih SF, Artura AM, Masamed R, Elashoff D, Wu HH, Calkins KL. Pregnancies complicated by gestational diabetes and fetal growth restriction: an analysis of maternal and fetal body composition using magnetic resonance imaging. J Perinatol 2023; 43:44-51. [PMID: 36319757 PMCID: PMC9840659 DOI: 10.1038/s41372-022-01549-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Maternal body composition may influence fetal body composition. OBJECTIVE The objective of this pilot study was to investigate the relationship between maternal and fetal body composition. METHODS Three pregnant women cohorts were studied: healthy, gestational diabetes (GDM), and fetal growth restriction (FGR). Maternal body composition (visceral adipose tissue volume (VAT), subcutaneous adipose tissue volume (SAT), pancreatic and hepatic proton-density fat fraction (PDFF) and fetal body composition (abdominal SAT and hepatic PDFF) were measured using MRI between 30 to 36 weeks gestation. RESULTS Compared to healthy and FGR fetuses, GDM fetuses had greater hepatic PDFF (5.2 [4.2, 5.5]% vs. 3.2 [3, 3.3]% vs. 1.9 [1.4, 3.7]%, p = 0.004). Fetal hepatic PDFF was associated with maternal SAT (r = 0.47, p = 0.02), VAT (r = 0.62, p = 0.002), and pancreatic PDFF (r = 0.54, p = 0.008). When controlling for maternal SAT, GDM increased fetal hepatic PDFF by 0.9 ([0.51, 1.3], p = 0.001). CONCLUSION In this study, maternal SAT, VAT, and GDM status were positively associated with fetal hepatic PDFF.
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Affiliation(s)
- Katie M. Strobel
- Department of Pediatrics, Division of Neonatology & Developmental Biology, University of California Los Angeles, Los Angeles, CA, USA
| | - Sevgi Gokce Kafali
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Shu-Fu Shih
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Rinat Masamed
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - David Elashoff
- University of California Los Angeles, Los Angeles, CA, USA
| | - Holden H. Wu
- Department of Medicine, Biostatistics and Computational Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Kara L. Calkins
- Department of Pediatrics, Division of Neonatology & Developmental Biology, University of California Los Angeles, Los Angeles, CA, USA
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Simoni P, Negro G, Moeremans M, Leucio AD. The Adolescent Spine. Semin Musculoskelet Radiol 2022; 26:501-509. [PMID: 36103891 DOI: 10.1055/s-0042-1755392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Adolescent idiopathic scoliosis (AIS) is the most characteristic disorder of the adolescent spine. It is a three-dimensional (3D) disorder that occurs from 10 years of age and comprises 90% of all idiopathic scolioses. Imaging plays a central role in the diagnosis and follow-up of patients with AIS. Modern imaging offers 3D assessment of scoliosis with less radiation exposure. Imaging helps rule out occult conditions that cause spinal deformity. Various imaging methods are also used to assess skeletal maturity in patients with AIS, thus determining the growth spurt and risk of progression of scoliosis. This article provides a brief overview of the pathophysiology, biomechanics, clinical features, and modern imaging of AIS relevant to radiologists in clinical settings.
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Affiliation(s)
- Paolo Simoni
- Department of Pediatric Imaging, Reine Fabiola Children's University Hospital, Université libre de Bruxelles, Brussels, Belgium
| | - Giulia Negro
- Department of Pediatric Imaging, Reine Fabiola Children's University Hospital, Université libre de Bruxelles, Brussels, Belgium
| | - Marine Moeremans
- Department of Pediatric Imaging, Reine Fabiola Children's University Hospital, Université libre de Bruxelles, Brussels, Belgium
| | - Alessandro De Leucio
- Department of Pediatric Imaging, Reine Fabiola Children's University Hospital, Université libre de Bruxelles, Brussels, Belgium
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Starekova J, Zhao R, Colgan TJ, Johnson KM, Rehm JL, Wells SA, Reeder SB, Hernando D. Improved free-breathing liver fat and iron quantification using a 2D chemical shift–encoded MRI with flip angle modulation and motion-corrected averaging. Eur Radiol 2022; 32:5458-5467. [DOI: 10.1007/s00330-022-08682-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/07/2022] [Accepted: 02/17/2022] [Indexed: 11/29/2022]
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Peng H, Cheng C, Wan Q, Jia S, Wang S, Lv J, Liang D, Liu W, Liu X, Zheng H, Zou C. Fast multi-parametric imaging in abdomen by B 1 + corrected dual-flip angle sequence with interleaved echo acquisition. Magn Reson Med 2021; 87:2194-2208. [PMID: 34888911 DOI: 10.1002/mrm.29127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/28/2021] [Accepted: 11/29/2021] [Indexed: 11/07/2022]
Abstract
PURPOSE To achieve simultaneous T1, w /proton density fat fraction (PDFF)/ R 2 ∗ mapping in abdomen within a single breadth-hold, and validate the accuracy using state-of-art measurement. THEORY AND METHODS An optimized multiple echo gradient echo (GRE) sequence with dual flip-angle acquisition was used to realize simultaneous water T1 (T1, w )/PDFF/ R 2 ∗ quantification. A new method, referred to as "solving the fat-water ambiguity based on their T1 difference" (SORT), was proposed to address the fat-water separation problem. This method was based on the finding that compared to the true solution, the wrong (or aliased) solution to fat-water separation problem showed extra dependency on the applied flip angle due to the T1 difference between fat and water. The B 1 + measurement sequence was applied to correct the B 1 + inhomogeneity for T1, w relaxometry. The 2D parallel imaging was incorporated to enable the acquisition within a single breath-hold in abdomen. RESULTS The multi-parametric quantification results of the proposed method were consistent with the results of reference methods in phantom experiments (PDFF quantification: R2 = 0.993, mean error 0.73%; T1, w quantification: R2 = 0.999, mean error 4.3%; R 2 ∗ quantification: R2 = 0.949, mean error 4.07 s-1 ). For volunteer studies, robust fat-water separation was achieved without evident fat-water swaps. Based on the accurate fat-water separation, simultaneous T1, w /PDFF/ R 2 ∗ quantification was realized for whole liver within a single breath-hold. CONCLUSION The proposed method accurately quantified T1, w /PDFF/ R 2 ∗ for the whole liver within a single breath-hold. This technique serves as a quantitative tool for disease management in patients with hepatic steatosis.
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Affiliation(s)
- Hao Peng
- School of Artificial Intelligence and Automation, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory for Magnetic Resonance and Multimodality Imaging of Guangdong Province, Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advance Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Chuanli Cheng
- Key Laboratory for Magnetic Resonance and Multimodality Imaging of Guangdong Province, Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advance Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Qian Wan
- Key Laboratory for Magnetic Resonance and Multimodality Imaging of Guangdong Province, Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advance Technology, Chinese Academy of Sciences, Shenzhen, China.,Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
| | - Sen Jia
- Key Laboratory for Magnetic Resonance and Multimodality Imaging of Guangdong Province, Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advance Technology, Chinese Academy of Sciences, Shenzhen, China.,Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
| | - Shuai Wang
- School of Artificial Intelligence and Automation, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory for Magnetic Resonance and Multimodality Imaging of Guangdong Province, Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advance Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Jianxun Lv
- Key Laboratory for Magnetic Resonance and Multimodality Imaging of Guangdong Province, Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advance Technology, Chinese Academy of Sciences, Shenzhen, China.,Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
| | - Dong Liang
- Key Laboratory for Magnetic Resonance and Multimodality Imaging of Guangdong Province, Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advance Technology, Chinese Academy of Sciences, Shenzhen, China.,Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
| | - Wenzhong Liu
- School of Artificial Intelligence and Automation, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Image Processing and Intelligent Control, Huazhong University of Science and Technology, Wuhan, China
| | - Xin Liu
- Key Laboratory for Magnetic Resonance and Multimodality Imaging of Guangdong Province, Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advance Technology, Chinese Academy of Sciences, Shenzhen, China.,Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
| | - Hairong Zheng
- Key Laboratory for Magnetic Resonance and Multimodality Imaging of Guangdong Province, Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advance Technology, Chinese Academy of Sciences, Shenzhen, China.,Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
| | - Chao Zou
- Key Laboratory for Magnetic Resonance and Multimodality Imaging of Guangdong Province, Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advance Technology, Chinese Academy of Sciences, Shenzhen, China.,Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
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Duffy PB, Stemmer A, Callahan MJ, Cravero JP, Johnston PR, Warfield SK, Bixby SD. Free-breathing radial stack-of-stars three-dimensional Dixon gradient echo sequence in abdominal magnetic resonance imaging in sedated pediatric patients. Pediatr Radiol 2021; 51:1645-1653. [PMID: 33830291 DOI: 10.1007/s00247-021-05054-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/30/2021] [Accepted: 03/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a strong need for improvements in motion robust T1-weighted abdominal imaging sequences in children to enable high-quality, free-breathing imaging. OBJECTIVE To compare imaging time and quality of a radial stack-of-stars, free-breathing T1-weighted gradient echo acquisition (volumetric interpolated breath-hold examination [VIBE]) three-dimensional (3-D) Dixon sequence in sedated pediatric patients undergoing abdominal magnetic resonance imaging (MRI) against conventional Cartesian T1-weighed sequences. MATERIALS AND METHODS This study was approved by the institutional review board with informed consent obtained from all subjects. Study subjects included 31 pediatric patients (19 male, 12 female; median age: 5 years; interquartile range: 5 years) undergoing abdominal MRI at 3 tesla with a free-breathing T1-weighted radial stack-of-stars 3-D VIBE Dixon prototype sequence, StarVIBE Dixon (radial technique), between October 2018 and June 2019 with previous abdominal MR imaging using conventional Cartesian T1-weighed imaging (traditional technique). MRI component times were recorded as well as the total number of non-contrast T1-weighted sequences. Two radiologists independently rated images for quality using a scale from 1 to 5 according to the following metrics: overall image quality, hepatic edge sharpness, hepatic vessel clarity and respiratory motion robustness. Scores were compared between the groups. RESULTS Mean T1-weighted imaging times for all subjects were 3.63 min for radial exams and 8.01 min for traditional exams (P<0.001), and total non-contrast imaging time was 32.7 min vs. 43.9 min (P=0.002). Adjusted mean total MRI time for all subjects was 60.2 min for radial exams and 65.7 min for traditional exams (P=0.387). The mean number of non-contrast T1-weighted sequences performed in radial MRI exams was 1.0 compared to 1.9 (range: 0-6) in traditional exams (P<0.001). StarVIBE Dixon outperformed Cartesian methods in all quality metrics. The mean overall image quality (scale 1-5) was 3.95 for radial exams and 3.31 for traditional exams (P<0.001). CONCLUSION Radial stack-of-stars 3-D VIBE Dixon during free-breathing abdominal MRI in pediatric patients offers improved image quality compared to Cartesian T1-weighted imaging techniques with decreased T1-weighted and total non-contrast imaging time. This has important implications for children undergoing sedation for imaging.
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Affiliation(s)
- Patrick B Duffy
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA
| | | | - Michael J Callahan
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA
| | - Joseph P Cravero
- Department of Anesthesiology, Boston Children's Hospital, Boston, MA, USA
| | - Patrick R Johnston
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA
| | - Simon K Warfield
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA
| | - Sarah D Bixby
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA.
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Simoni P, Guglielmi R, Aparisi Gómez MP. Imaging of body composition in children. Quant Imaging Med Surg 2020; 10:1661-1671. [PMID: 32742959 DOI: 10.21037/qims.2020.04.06] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Overweight and obesity in children and adolescents have become a worldwide public health concern with an ever-increasing prevalence. An excessive accumulation of intraabdominal fat tissue increases the risk of developing insulin resistance, diabetes, and cardiovascular diseases in adulthood. Body composition has a role in metabolism regulation in children and adolescents with differences between genders and age groups. Until recently, Air Displacement Plethysmography and Dual-energy X-ray Absorptiometry (DXA) have been the most common techniques used to assess body composition in children. Ultrasound (US) is an accurate, readily available, and radiation-free technique to quantify intra-abdominal fat in adults, but its use in children has not yet been validated. Computed tomography (CT) is a reliable tool to assess body composition, but its use in children should be avoided due to the significant radiation burden. Quantitative Magnetic Resonance Imaging (qMRI) provides an accurate measurement of body composition, through the quantification of the visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and brown adipose tissue (BAT), as well as lean mass. Furthermore, qMRI provides other significant estimates such as the Proton Density Fat-Fraction of the fat tissue. This review article aims to briefly describe the state of art of the advanced imaging techniques to provide a quantitative assessment of body composition in children and adolescents.
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Affiliation(s)
- Paolo Simoni
- Pediatric Imaging, Diagnostic Imaging Department, Queen Fabiola Children's University Hospital, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Riccardo Guglielmi
- Department of Radiology, St Gallen University Hospital, Kantonal Hospital Müsterlingen, Münsterlingen, Switzerland
| | - Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, Auckland, New Zealand.,Department of Radiology, Hospital Vithas Nueve de Octubre, Valencia, Spain
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