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Kahraman G, Haberal KM, Dilek ON. Imaging features and management of focal liver lesions. World J Radiol 2024; 16:139-167. [DOI: 10.4329/wjr.v16.i6.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/28/2024] [Accepted: 05/22/2024] [Indexed: 06/26/2024] Open
Abstract
Notably, the number of incidentally detected focal liver lesions (FLLs) has increased dramatically in recent years due to the increased use of radiological imaging. The diagnosis of FLLs can be made through a well-documented medical history, physical examination, laboratory tests, and appropriate imaging methods. Although benign FLLs are more common than malignant ones in adults, even in patients with primary malignancy, accurate diagnosis of incidental FLLs is of utmost clinical significance. In clinical practice, FLLs are frequently evaluated non-invasively using ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). Although US is a cost-effective and widely used imaging method, its diagnostic specificity and sensitivity for FLL characterization are limited. FLLs are primarily characterized by obtaining enhancement patterns through dynamic contrast-enhanced CT and MRI. MRI is a problem-solving method with high specificity and sensitivity, commonly used for the evaluation of FLLs that cannot be characterized by US or CT. Recent technical advancements in MRI, along with the use of hepatobiliary-specific MRI contrast agents, have significantly improved the success of FLL characterization and reduced unnecessary biopsies. The American College of Radiology (ACR) appropriateness criteria are evidence-based recommendations intended to assist clinicians in selecting the optimal imaging or treatment option for their patients. ACR Appropriateness Criteria Liver Lesion-Initial Characterization guideline provides recommendations for the imaging methods that should be used for the characterization of incidentally detected FLLs in various clinical scenarios. The American College of Gastroenterology (ACG) Clinical Guideline offers evidence-based recommendations for both the diagnosis and management of FLL. American Association for the Study of Liver Diseases (AASLD) Practice Guidance provides an approach to the diagnosis and management of patients with hepatocellular carcinoma. In this article, FLLs are reviewed with a comprehensive analysis of ACR Appropriateness Criteria, ACG Clinical Guideline, AASLD Practice Guidance, and current medical literature from peer-reviewed journals. The article includes a discussion of imaging methods used for the assessment of FLL, current recommended imaging techniques, innovations in liver imaging, contrast agents, imaging features of common nonmetastatic benign and malignant FLL, as well as current management recommendations.
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Affiliation(s)
- Gökhan Kahraman
- Department of Radiology, Suluova State Hospital, Amasya 05500, Türkiye
| | - Kemal Murat Haberal
- Department of Radiology, Başkent University Faculty of Medicine, Ankara 06490, Türkiye
| | - Osman Nuri Dilek
- Department of Surgery, İzmir Katip Celebi University, School of Medicine, İzmir 35150, Türkiye
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2
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Ozkaya E, Kennedy P, Chen J, Bane O, Dillman JR, Jhaveri KS, Ohliger MA, Rossman PJ, Tkach JA, Doucette JT, Venkatesh SK, Ehman RL, Taouli B. Precision and Test-Retest Repeatability of Stiffness Measurement with MR Elastography: A Multicenter Phantom Study. Radiology 2024; 311:e233136. [PMID: 38742971 PMCID: PMC11140535 DOI: 10.1148/radiol.233136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 03/14/2024] [Accepted: 03/26/2024] [Indexed: 05/16/2024]
Abstract
Background MR elastography (MRE) has been shown to have excellent performance for noninvasive liver fibrosis staging. However, there is limited knowledge regarding the precision and test-retest repeatability of stiffness measurement with MRE in the multicenter setting. Purpose To determine the precision and test-retest repeatability of stiffness measurement with MRE across multiple centers using the same phantoms. Materials and Methods In this study, three cylindrical phantoms made of polyvinyl chloride gel mimicking different degrees of liver stiffness in humans (phantoms 1-3: soft, medium, and hard stiffness, respectively) were evaluated. Between January 2021 and January 2022, phantoms were circulated between five different centers and scanned with 10 MRE-equipped clinical 1.5-T and 3-T systems from three major vendors, using two-dimensional (2D) gradient-recalled echo (GRE) imaging and/or 2D spin-echo (SE) echo-planar imaging (EPI). Similar MRE acquisition parameters, hardware, and reconstruction algorithms were used at each center. Mean stiffness was measured by a single observer for each phantom and acquisition on a single section. Stiffness measurement precision and same-session test-retest repeatability were assessed using the coefficient of variation (CV) and the repeatability coefficient (RC), respectively. Results The mean precision represented by the CV was 5.8% (95% CI: 3.8, 7.7) for all phantoms and both sequences combined. For all phantoms, 2D GRE achieved a CV of 4.5% (95% CI: 3.3, 5.7) whereas 2D SE EPI achieved a CV of 7.8% (95% CI: 3.1, 12.6). The mean RC of stiffness measurement was 5.8% (95% CI: 3.7, 7.8) for all phantoms and both sequences combined, 4.9% (95% CI: 2.7, 7.0) for 2D GRE, and 7.0% (95% CI: 2.9, 11.2) for 2D SE EPI (all phantoms). Conclusion MRE had excellent in vitro precision and same-session test-retest repeatability in the multicenter setting when similar imaging protocols, hardware, and reconstruction algorithms were used. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Tang in this issue.
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Affiliation(s)
| | | | - Jun Chen
- From the BioMedical Engineering and Imaging Institute (E.O., P.K.,
O.B., B.T.) and Departments of Diagnostic, Molecular and Interventional
Radiology (E.O., P.K., O.B., B.T.) Environmental Medicine and Public Health
(J.T.D.), Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York,
NY 10029; Department of Radiology, Mayo Clinic, Rochester, Minn (J.C., P.J.R.,
S.K.V., R.L.E.); Department of Radiology, Nanjing University Medical School
Affiliated Drum Tower Hospital, Nanjing, China (J.C.); Department of Radiology,
Cincinnati Children’s Hospital Medical Center, University of Cincinnati
College of Medicine, Cincinnati, Ohio (J.R.D., J.A.T.); Joint Department of
Medical Imaging, University Health Network, Mount Sinai Hospital, and
Women’s College Hospital, University of Toronto, Toronto, Canada
(K.S.J.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, Calif (M.A.O.); and Department of Radiology,
Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.)
| | - Octavia Bane
- From the BioMedical Engineering and Imaging Institute (E.O., P.K.,
O.B., B.T.) and Departments of Diagnostic, Molecular and Interventional
Radiology (E.O., P.K., O.B., B.T.) Environmental Medicine and Public Health
(J.T.D.), Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York,
NY 10029; Department of Radiology, Mayo Clinic, Rochester, Minn (J.C., P.J.R.,
S.K.V., R.L.E.); Department of Radiology, Nanjing University Medical School
Affiliated Drum Tower Hospital, Nanjing, China (J.C.); Department of Radiology,
Cincinnati Children’s Hospital Medical Center, University of Cincinnati
College of Medicine, Cincinnati, Ohio (J.R.D., J.A.T.); Joint Department of
Medical Imaging, University Health Network, Mount Sinai Hospital, and
Women’s College Hospital, University of Toronto, Toronto, Canada
(K.S.J.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, Calif (M.A.O.); and Department of Radiology,
Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.)
| | - Jonathan R. Dillman
- From the BioMedical Engineering and Imaging Institute (E.O., P.K.,
O.B., B.T.) and Departments of Diagnostic, Molecular and Interventional
Radiology (E.O., P.K., O.B., B.T.) Environmental Medicine and Public Health
(J.T.D.), Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York,
NY 10029; Department of Radiology, Mayo Clinic, Rochester, Minn (J.C., P.J.R.,
S.K.V., R.L.E.); Department of Radiology, Nanjing University Medical School
Affiliated Drum Tower Hospital, Nanjing, China (J.C.); Department of Radiology,
Cincinnati Children’s Hospital Medical Center, University of Cincinnati
College of Medicine, Cincinnati, Ohio (J.R.D., J.A.T.); Joint Department of
Medical Imaging, University Health Network, Mount Sinai Hospital, and
Women’s College Hospital, University of Toronto, Toronto, Canada
(K.S.J.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, Calif (M.A.O.); and Department of Radiology,
Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.)
| | - Kartik S. Jhaveri
- From the BioMedical Engineering and Imaging Institute (E.O., P.K.,
O.B., B.T.) and Departments of Diagnostic, Molecular and Interventional
Radiology (E.O., P.K., O.B., B.T.) Environmental Medicine and Public Health
(J.T.D.), Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York,
NY 10029; Department of Radiology, Mayo Clinic, Rochester, Minn (J.C., P.J.R.,
S.K.V., R.L.E.); Department of Radiology, Nanjing University Medical School
Affiliated Drum Tower Hospital, Nanjing, China (J.C.); Department of Radiology,
Cincinnati Children’s Hospital Medical Center, University of Cincinnati
College of Medicine, Cincinnati, Ohio (J.R.D., J.A.T.); Joint Department of
Medical Imaging, University Health Network, Mount Sinai Hospital, and
Women’s College Hospital, University of Toronto, Toronto, Canada
(K.S.J.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, Calif (M.A.O.); and Department of Radiology,
Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.)
| | - Michael A. Ohliger
- From the BioMedical Engineering and Imaging Institute (E.O., P.K.,
O.B., B.T.) and Departments of Diagnostic, Molecular and Interventional
Radiology (E.O., P.K., O.B., B.T.) Environmental Medicine and Public Health
(J.T.D.), Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York,
NY 10029; Department of Radiology, Mayo Clinic, Rochester, Minn (J.C., P.J.R.,
S.K.V., R.L.E.); Department of Radiology, Nanjing University Medical School
Affiliated Drum Tower Hospital, Nanjing, China (J.C.); Department of Radiology,
Cincinnati Children’s Hospital Medical Center, University of Cincinnati
College of Medicine, Cincinnati, Ohio (J.R.D., J.A.T.); Joint Department of
Medical Imaging, University Health Network, Mount Sinai Hospital, and
Women’s College Hospital, University of Toronto, Toronto, Canada
(K.S.J.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, Calif (M.A.O.); and Department of Radiology,
Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.)
| | - Phillip J. Rossman
- From the BioMedical Engineering and Imaging Institute (E.O., P.K.,
O.B., B.T.) and Departments of Diagnostic, Molecular and Interventional
Radiology (E.O., P.K., O.B., B.T.) Environmental Medicine and Public Health
(J.T.D.), Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York,
NY 10029; Department of Radiology, Mayo Clinic, Rochester, Minn (J.C., P.J.R.,
S.K.V., R.L.E.); Department of Radiology, Nanjing University Medical School
Affiliated Drum Tower Hospital, Nanjing, China (J.C.); Department of Radiology,
Cincinnati Children’s Hospital Medical Center, University of Cincinnati
College of Medicine, Cincinnati, Ohio (J.R.D., J.A.T.); Joint Department of
Medical Imaging, University Health Network, Mount Sinai Hospital, and
Women’s College Hospital, University of Toronto, Toronto, Canada
(K.S.J.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, Calif (M.A.O.); and Department of Radiology,
Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.)
| | - Jean A. Tkach
- From the BioMedical Engineering and Imaging Institute (E.O., P.K.,
O.B., B.T.) and Departments of Diagnostic, Molecular and Interventional
Radiology (E.O., P.K., O.B., B.T.) Environmental Medicine and Public Health
(J.T.D.), Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York,
NY 10029; Department of Radiology, Mayo Clinic, Rochester, Minn (J.C., P.J.R.,
S.K.V., R.L.E.); Department of Radiology, Nanjing University Medical School
Affiliated Drum Tower Hospital, Nanjing, China (J.C.); Department of Radiology,
Cincinnati Children’s Hospital Medical Center, University of Cincinnati
College of Medicine, Cincinnati, Ohio (J.R.D., J.A.T.); Joint Department of
Medical Imaging, University Health Network, Mount Sinai Hospital, and
Women’s College Hospital, University of Toronto, Toronto, Canada
(K.S.J.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, Calif (M.A.O.); and Department of Radiology,
Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.)
| | - John T. Doucette
- From the BioMedical Engineering and Imaging Institute (E.O., P.K.,
O.B., B.T.) and Departments of Diagnostic, Molecular and Interventional
Radiology (E.O., P.K., O.B., B.T.) Environmental Medicine and Public Health
(J.T.D.), Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York,
NY 10029; Department of Radiology, Mayo Clinic, Rochester, Minn (J.C., P.J.R.,
S.K.V., R.L.E.); Department of Radiology, Nanjing University Medical School
Affiliated Drum Tower Hospital, Nanjing, China (J.C.); Department of Radiology,
Cincinnati Children’s Hospital Medical Center, University of Cincinnati
College of Medicine, Cincinnati, Ohio (J.R.D., J.A.T.); Joint Department of
Medical Imaging, University Health Network, Mount Sinai Hospital, and
Women’s College Hospital, University of Toronto, Toronto, Canada
(K.S.J.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, Calif (M.A.O.); and Department of Radiology,
Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.)
| | - Sudhakar K. Venkatesh
- From the BioMedical Engineering and Imaging Institute (E.O., P.K.,
O.B., B.T.) and Departments of Diagnostic, Molecular and Interventional
Radiology (E.O., P.K., O.B., B.T.) Environmental Medicine and Public Health
(J.T.D.), Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York,
NY 10029; Department of Radiology, Mayo Clinic, Rochester, Minn (J.C., P.J.R.,
S.K.V., R.L.E.); Department of Radiology, Nanjing University Medical School
Affiliated Drum Tower Hospital, Nanjing, China (J.C.); Department of Radiology,
Cincinnati Children’s Hospital Medical Center, University of Cincinnati
College of Medicine, Cincinnati, Ohio (J.R.D., J.A.T.); Joint Department of
Medical Imaging, University Health Network, Mount Sinai Hospital, and
Women’s College Hospital, University of Toronto, Toronto, Canada
(K.S.J.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, Calif (M.A.O.); and Department of Radiology,
Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.)
| | - Richard L. Ehman
- From the BioMedical Engineering and Imaging Institute (E.O., P.K.,
O.B., B.T.) and Departments of Diagnostic, Molecular and Interventional
Radiology (E.O., P.K., O.B., B.T.) Environmental Medicine and Public Health
(J.T.D.), Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York,
NY 10029; Department of Radiology, Mayo Clinic, Rochester, Minn (J.C., P.J.R.,
S.K.V., R.L.E.); Department of Radiology, Nanjing University Medical School
Affiliated Drum Tower Hospital, Nanjing, China (J.C.); Department of Radiology,
Cincinnati Children’s Hospital Medical Center, University of Cincinnati
College of Medicine, Cincinnati, Ohio (J.R.D., J.A.T.); Joint Department of
Medical Imaging, University Health Network, Mount Sinai Hospital, and
Women’s College Hospital, University of Toronto, Toronto, Canada
(K.S.J.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, Calif (M.A.O.); and Department of Radiology,
Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.)
| | - Bachir Taouli
- From the BioMedical Engineering and Imaging Institute (E.O., P.K.,
O.B., B.T.) and Departments of Diagnostic, Molecular and Interventional
Radiology (E.O., P.K., O.B., B.T.) Environmental Medicine and Public Health
(J.T.D.), Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York,
NY 10029; Department of Radiology, Mayo Clinic, Rochester, Minn (J.C., P.J.R.,
S.K.V., R.L.E.); Department of Radiology, Nanjing University Medical School
Affiliated Drum Tower Hospital, Nanjing, China (J.C.); Department of Radiology,
Cincinnati Children’s Hospital Medical Center, University of Cincinnati
College of Medicine, Cincinnati, Ohio (J.R.D., J.A.T.); Joint Department of
Medical Imaging, University Health Network, Mount Sinai Hospital, and
Women’s College Hospital, University of Toronto, Toronto, Canada
(K.S.J.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, Calif (M.A.O.); and Department of Radiology,
Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.)
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Abe R, Fukuzawa K, Yoshihara C, Tano M, Saitoh S. Comparison of spin-echo echo planar imaging and gradient-recalled echo sequences in magnetic resonance elastography of liver at 1.5T same MRI scanner. Abdom Radiol (NY) 2024; 49:694-702. [PMID: 38012395 DOI: 10.1007/s00261-023-04098-3] [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: 06/23/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE Magnetic resonance elastography (MRE) is used to measure liver stiffness with gradient-recalled echo (GRE)-based and spin-echo echo planar imaging (SE-EPI)-based sequences. We compared the liver stiffness (LS) values of the two sequences on a 1.5-T MR imaging scanner. METHODS This is a retrospective study. An MRE imaging section was obtained from a horizontal section of the liver. Region of interest was drawn on the elastogram, and the mean LS and pixel values were measured and compared. The correlations between proton density fat fraction, R2* values, and biochemical data from electronic medical records were confirmed, and multivariate analysis was performed. RESULTS The mean LS values were 3.01 ± 1.78 kPa for GRE and 3.13 ± 1.57 kPa for SE-EPI, showing excellent agreement and a strong correlation between the two sequences (correlation coefficient r = 0.96). The mean pixel values were 369.5 ± 142.7 pixels for GRE and 490.1 ± 197.9 pixels for SE-EPI, showing a significant difference by the Wilcoxon rank sum test (p < 0.01). There were no LS unmeasurable cases in SE-EPI, but seven (2.5%) were unmeasurable in GRE, and multivariate analysis showed a significant difference with p < 0.001 in R2* values (mean, 92.7 Hz) for the GRE method. CONCLUSION The GRE and SE-EPI methods were comparable for LS measurements in 1.5-T liver MRE, indicating that SE-EPI MRE is more useful because GRE MRE may not measure cases with high R2* values and the region of interest tends to be smaller.
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Affiliation(s)
- Ryouna Abe
- Department of Radiological Technology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, Japan.
| | - Kei Fukuzawa
- Department of Radiological Technology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, Japan
| | - Chiharu Yoshihara
- Department of Radiological Technology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, Japan
| | - Masakatsu Tano
- Department of Radiological Technology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, Japan
| | - Satoshi Saitoh
- Department of Hepatology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, Japan
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Serai SD, Franchi-Abella S, Syed AB, Tkach JA, Toso S, Ferraioli G. MR and Ultrasound Elastography for Fibrosis Assessment in Children: Practical Implementation and Supporting Evidence- AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2024. [PMID: 38170833 DOI: 10.2214/ajr.23.30506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Quantitative MRI and ultrasound biomarkers of liver fibrosis have become important tools in the diagnosis and clinical management of children with chronic liver disease (CLD). In particular, MR elastography (MRE) is now routinely performed in clinical practice to evaluate the liver for fibrosis. Ultrasound shear-wave elastography has also become widely performed for this purpose, especially in young children. These noninvasive methods are increasingly used to replace liver biopsy for the diagnosis, quantitative staging, and treatment monitoring of patients with CLD. Although ultrasound has advantages of portability and lower equipment cost, available evidence indicates that MRI may have greater reliability and accuracy in liver fibrosis evaluation. In this AJR Expert Panel Narrative Review, we describe how, why, and when to use MRI- and ultrasound-based elastography methods for liver fibrosis assessment in children. Practical approaches are discussed for adapting and optimizing these methods in children, with consideration of clinical indications, patient preparation, equipment requirements, acquisition technique, as well as pitfalls and confounding factors. Guidance is provided for interpretation and reporting, and representative case examples are presented.
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Affiliation(s)
- Suraj D Serai
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia PA
| | - Stéphanie Franchi-Abella
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- AP-HP, Centre de Référence des maladies rares du foie de l'enfant, Service de radiologie pédiatrique diagnostique et interventionnelle, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- BIOMAPS UMR 9011 CNRS, Inserm, CEA, Orsay, France
| | - Ali B Syed
- Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Seema Toso
- Department of Pediatric Radiology, University Children's Hospital Geneva, 6 rue Willy Donzé, CH 1211, Genéve 14, Suisse
| | - Giovanna Ferraioli
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, Medical School University of Pavia, Pavia 27100, Italy
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Elsingergy MM, Viteri B, Otero HJ, Bhatti T, Morales T, Roberts TPL, Amaral S, Hartung E, Serai SD. Imaging fibrosis in pediatric kidney transplantation: A pilot study. Pediatr Transplant 2023; 27:e14540. [PMID: 37166372 PMCID: PMC10824264 DOI: 10.1111/petr.14540] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/01/2023] [Accepted: 04/28/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Noninvasive alternatives to biopsy for assessment of interstitial fibrosis and tubular atrophy (IFTA), the major determinant of kidney transplant failure, remain profoundly limited. Elastography is a noninvasive technique that propagates shear waves across tissues to measure their stiffness. We aimed to test utility of elastography for early detection of IFTA in pediatric kidney allografts. METHODS We compared ultrasound (USE) and MR elastography (MRE) stiffness measurements, performed on pediatric transplant recipients referred for clinically indicated biopsies, and healthy controls. RESULTS Ten transplant recipients (median age 16 years) and eight controls (median age 16.5 years) were enrolled. Three transplant recipients had "stable" allografts and seven had Banff Grade 1 IFTA. Median time from transplantation to biopsy was 12 months. Mean estimated glomerular filtration rate was 61.5 mL/min/1.73m2 by creatinine-cystatin-C CKiD equation at time of biopsy. Mean stiffness, calculated through one-way ANOVA, was higher for IFTA allografts (23.4 kPa USE/5.6 kPa MRE) than stable allografts (13.7 kPa USE/4.4 kPa MRE) and controls (9.1 kPa USE/3.6 kPa MRE). Pearson's coefficient between USE and MRE stiffness values was strong (r = .97). AUC for fibrosis prediction in transplanted kidneys was high for both modalities (0.91 USE and 0.89 MRE), although statistically nonsignificant (p > .05). Stiffness cut-off values for USE and MRE were 13.8 kPa and 4.6 kPa, respectively. Both values yielded a sensitivity of 100% but USE specificity (72%) was slightly higher than MRE (67%). CONCLUSION Elastography shows potential for detection of low-grade IFTA in allografts although a larger sample is imperative for clinical validation.
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Affiliation(s)
| | - Bernarda Viteri
- Department of Pediatrics, Division of Nephrology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Hansel J. Otero
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Tricia Bhatti
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Tatiana Morales
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Timothy P L Roberts
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sandra Amaral
- Department of Pediatrics, Division of Nephrology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Erum Hartung
- Department of Pediatrics, Division of Nephrology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Suraj D. Serai
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Hazhirkarzar B, Wu Q, Tang H, Baghdadi A, Motaghi M, Habibabadi RR, Shaghaghi M, Ghadimi M, Borhani A, Mohseni A, Pan L, BolsterJr BD, Kamel IR. Comparison between Gradient-Echo and Spin-Echo EPI MR Elastography at 3 T in quantifying liver stiffness of patients with and without iron overload; a prospective study. Clin Imaging 2023; 100:42-47. [PMID: 37196504 DOI: 10.1016/j.clinimag.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/28/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVES To compare the maximum axial area of the confidence mask and the calculated liver stiffness (LS) on gradient-echo (GRE) and spin-echo echo planar imaging (SE-EPI) MR elastography (MRE) in patients with and without iron deposition. METHODS 104 patients underwent MRE by GRE and SE-EPI sequences at 3 T. R2* values >88 Hz in the liver were categorized in the iron overload group. The maximum axial area and the corresponding LS values were measured by manually contouring the whole area on one slice with the largest confidence mask at both GRE and SE-EPI sequences. RESULTS In patients with iron overload, SE-EPI provided larger maximum axial confidence area in unfailed images (57.6 ± 41.7 cm2) compared to GRE (45.7 ± 29.1 cm2) (p-value = 0.007). In five patients with iron overload, imaging failed at GRE sequence, whereas at the SE-EPI sequence the maximum area of the confidence mask had a mean value of 33.5 ± 54.9 cm2. In livers without iron overload (R2*: 50.7 ± 13.1 Hz), the maximum area on the confidence mask was larger at SE-EPI (118.3 ± 41.2 cm2) than on GRE (105.1 ± 31.7 cm2) (P-value = 0.003). There was no significant difference in mean LS between SE-EPI (2.0 ± 0.3 kPa) and GRE (2.1 ± 0.5 kPa) in livers with iron overload (P value = 0.24). Similarly, in the group without iron overload, mean LS was 2.3 ± 0.7 kPa at SE-EPI and 2.4 ± 0.8 kPa at GRE sequences (P-value = 0.11). CONCLUSIONS SE-EPI MRE can successfully provide similar LS measurements as GRE MRE. Furthermore, it provides a larger measurable area on the confidence mask in both groups with and without iron overload.
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Affiliation(s)
- Bita Hazhirkarzar
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Qingxia Wu
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Hao Tang
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Azarakhsh Baghdadi
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Mina Motaghi
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Roya Rezvani Habibabadi
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Mohammadreza Shaghaghi
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Maryam Ghadimi
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ali Borhani
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Alireza Mohseni
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Li Pan
- Siemens Healthineers, Baltimore, MD, USA
| | | | - Ihab R Kamel
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
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Polycystic Kidney Disease Drug Development: A Conference Report. Kidney Med 2022; 5:100596. [PMID: 36698747 PMCID: PMC9867973 DOI: 10.1016/j.xkme.2022.100596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is part of a spectrum of inherited diseases that also includes autosomal recessive polycystic kidney disease, autosomal dominant polycystic liver disease, and an expanding group of recessively inherited disorders collectively termed hepatorenal fibrocystic disorders. ADPKD is the most common monogenic disorder frequently leading to chronic kidney failure with an estimated prevalence of 12 million people worldwide. Currently, only one drug (tolvaptan) has been approved by regulatory agencies as disease-modifying therapy for ADPKD, but, given its mechanism of action and side effect profile, the need for an improved therapy for ADPKD remains a priority. Although significant regulatory progress has been made, with qualification of total kidney volume as a prognostic enrichment biomarker and its later designation as a reasonably likely surrogate endpoint for progression of ADPKD within clinical trials, further work is needed to accelerate drug development efforts for all forms of PKD. In May 2021, the PKD Outcomes Consortium at the Critical Path Institute and the PKD Foundation organized a PKD Regulatory Summit to spur conversations among patients, industry, academic, and regulatory stakeholders regarding future development of tools and drugs for ADPKD and autosomal recessive polycystic kidney disease. This Special Report reviews the key points discussed during the summit and provides future direction related to PKD drug development tools.
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Serai SD, Elsingergy MM, Hartung EA, Otero HJ. Liver and spleen volume and stiffness in patients post-Fontan procedure and patients with ARPKD compared to normal controls. Clin Imaging 2022; 89:147-154. [PMID: 35835018 DOI: 10.1016/j.clinimag.2022.06.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE Both congestive (patients post-Fontan hepatopathy) and congenital (patients with ARPKD) disease can lead to hepatic fibrosis and portal hypertension with eventual development of splenomegaly. We investigated liver and spleen stiffness as measured by MRE between post-Fontan, ARPKD patients and controls independent of organ volume. METHODS Our study included 122 subjects (70 Fontan patients, 14 ARPKD patients, and 38 controls). The mean MRE liver and spleen stiffness values of Fontan patients and patients with ARPKD were compared to controls. Similarly, the liver and spleen volumes of the Fontan patients and patients with ARPKD were then compared to the volumes of controls. RESULTS Post-Fontan and ARPKD patients, mean liver stiffness, mean liver volume as well as mean spleen stiffness and mean spleen volume were higher than mean liver stiffness, mean liver volume, mean spleen stiffness, and mean spleen volume of controls. While liver stiffness correlated to liver volume in controls, we found no correlation between stiffness and volume in either Fontan or ARPKD patients, which indicates MRE's ability to act as an independent biomarker. However, these findings are not true in the spleen, where there is significant association between volume and stiffness in patients with ARPKD, but not in Fontan patients or controls. CONCLUSION Liver and spleen stiffness and volumes are significantly different among Fontan patients, ARPKD patients, and controls. Our findings suggest that beyond diagnosing fibrosis, MRE cut-off values could be disease-specific since not only the severity but the underlying pathology causing organ congestion or fibrosis influences MRE results.
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Affiliation(s)
- Suraj D Serai
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Mohamed M Elsingergy
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Erum A Hartung
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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9
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Serai S, Tsitsiou Y, Wilkins B, Ghosh A, Cahill A, Biko D, Rychik J, Rand E, Goldberg D. MR elastography-based staging of liver fibrosis in Fontan procedure associated liver disease is confounded by effects of venous congestion. Clin Radiol 2022; 77:e776-e782. [DOI: 10.1016/j.crad.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/31/2022] [Accepted: 06/24/2022] [Indexed: 11/03/2022]
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Dana J, Girard M, Franchi-Abella S, Berteloot L, Benoit-Cherifi M, Imbert-Bismut F, Sermet-Gaudelus I, Debray D. Comparison of Transient Elastography, ShearWave Elastography, Magnetic Resonance Elastography and FibroTest as routine diagnostic markers for assessing liver fibrosis in children with Cystic Fibrosis. Clin Res Hepatol Gastroenterol 2022; 46:101855. [PMID: 34933150 DOI: 10.1016/j.clinre.2021.101855] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 12/10/2021] [Accepted: 12/10/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Reliable markers are needed for early diagnosis and follow-up of liver disease in Cystic Fibrosis (CF). The objective was to evaluate the diagnostic performance of Transient Elastography (TE), Real-Time ShearWave Ultrasound Elastography (SWE), Magnetic Resonance Elastography (MRE) and the FibroTest as markers of Cystic Fibrosis Liver Disease (CFLD). METHODS A monocentric prospective cross-modality comparison study was proposed to all children (6 to 18 years of age) attending the CF center. Based on liver ultrasound findings, participants were classified into 3 groups: multinodular liver or portal hypertension (Nodular US/PH, advanced CFLD), heterogeneous increased echogenicity (Heterogeneous US, CFLD) or neither (Normal/Homogeneous US, no CFLD). The 4 tests were performed on the same day. The primary outcome was the FibroTest value and liver stiffness measurements (LSM). RESULTS 55 participants (mean age 12.6 ± 3.3 years; 25 girls) were included between 2015 and 2018: 23 in group Nodular US/PH, 8 in group Heterogeneous US and 24 in group Normal/Homogeneous US (including 4 with steatosis). LSM on TE, SWE and MRE were higher in participants with CFLD (groups Nodular US/PH and Heterogeneous US) compared to others (group Normal/Homogeneous US) (p<0.01), while FibroTest values did not differ (p = 0.09). The optimal cut-off values for predicting CFLD on TE, SWE and MRE were 8.7 (AUC=0.83, Se=0.71, Sp=0.96), 7.8 (AUC=0.85, Se=0.73, Sp=0.96) and 4.15 kPa (AUC=0.68, Se=0.73, Sp=0.64), respectively. LSM predicted the occurrence of major liver-related events at 3 years. TE and SWE were highly correlated (Spearman's ρ=0.9) and concordant in identifying advanced CFLD (Cohen's κ=0.84) while MRE was moderately correlated and concordant with TE (ρ=0.41; κ=36) and SWE (ρ=0.5; κ=0.50). CONCLUSION This study demonstrated excellent diagnostic performance of TE, SWE and MRE for the diagnosis of CFLD.
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Affiliation(s)
- Jérémy Dana
- Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, AP-HP, Paris, France; IHU-Strasbourg (Institut Hospitalo-Universitaire), Strasbourg, France; Institut National de la Santé et de la Recherche Médicale (Inserm), U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Strasbourg, France.
| | - Muriel Girard
- Pediatric Hepatology unit, Centre de Référence Maladies Rares (CRMR) de l'atrésie des voies biliaires et cholestases génétiques (AVB-CG), National network for rare liver diseases (Filfoie), ERN rare liver, Hôpital Necker-Enfants Malades, AP-HP, Université de Paris, Paris, France; Inserm U1151, Institut Necker-Enfants Malades, Paris, France
| | - Stéphanie Franchi-Abella
- Department of Pediatric Radiology, APHP-Bicêtre Hospital, UMR BioMaps Paris-Saclay, Paris Saclay University, Kremlin-Bicêtre, France
| | - Laureline Berteloot
- Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | | | - Françoise Imbert-Bismut
- Department of Metabolic Biochemistry, Hôpital Pitié Salpétrière Charlefoix, AP-HP, Paris, France; Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Isabelle Sermet-Gaudelus
- Centre de Référence Maladies Rares (CRMR), Mucoviscidose et maladies de CFTR, European Respiratory Network Lung, Hôpital Necker-Enfants Malades, AP-HP, Université de Paris, Paris, France; Inserm U1121, Necker-Enfants Malades Institute, Paris, France
| | - Dominique Debray
- Pediatric Hepatology unit, Centre de Référence Maladies Rares (CRMR) de l'atrésie des voies biliaires et cholestases génétiques (AVB-CG), National network for rare liver diseases (Filfoie), ERN rare liver, Hôpital Necker-Enfants Malades, AP-HP, Université de Paris, Paris, France; Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
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11
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Magnetic resonance elastography of the liver: everything you need to know to get started. Abdom Radiol (NY) 2022; 47:94-114. [PMID: 34725719 DOI: 10.1007/s00261-021-03324-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 12/17/2022]
Abstract
Magnetic resonance elastography (MRE) of the liver has emerged as the non-invasive standard for the evaluation of liver fibrosis in chronic liver diseases (CLDs). The utility of MRE in the evaluation of different CLD in both adults and children has been demonstrated in several studies, and MRE has been recommended by several clinical societies. Consequently, the clinical indications for evaluation of CLD with MRE have increased, and MRE is currently used as an add-on test during routine liver MRI studies or as a standalone test. To meet the increasing clinical demand, MRE is being installed in many academic and private practice imaging centers. There is a need for a comprehensive practical guide to help these practices to deliver high-quality liver MRE studies as well as troubleshoot the common issues with MRE to ensure smooth running of the service. This comprehensive clinical practice review summarizes the indications and provides an overview on why to use MRE, technical requirements, system set-up, patient preparation, acquiring the data, and interpretation.
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Kafali SG, Armstrong T, Shih SF, Kim GJ, Holtrop JL, Venick RS, Ghahremani S, Bolster BD, Hillenbrand CM, Calkins KL, Wu HH. Free-breathing radial magnetic resonance elastography of the liver in children at 3 T: a pilot study. Pediatr Radiol 2022; 52:1314-1325. [PMID: 35366073 PMCID: PMC9192470 DOI: 10.1007/s00247-022-05297-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/02/2021] [Accepted: 01/20/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Magnetic resonance (MR) elastography of the liver measures hepatic stiffness, which correlates with the histopathological staging of liver fibrosis. Conventional Cartesian gradient-echo (GRE) MR elastography requires breath-holding, which is challenging for children. Non-Cartesian radial free-breathing MR elastography is a potential solution to this problem. OBJECTIVE To investigate radial free-breathing MR elastography for measuring hepatic stiffness in children. MATERIALS AND METHODS In this prospective pilot study, 14 healthy children and 9 children with liver disease were scanned at 3 T using 2-D Cartesian GRE breath-hold MR elastography (22 s/slice) and 2-D radial GRE free-breathing MR elastography (163 s/slice). Each sequence was acquired twice. Agreement in the stiffness measurements was evaluated using Lin's concordance correlation coefficient (CCC) and within-subject mean difference. The repeatability was assessed using the within-subject coefficient of variation and intraclass correlation coefficient (ICC). RESULTS Fourteen healthy children and seven children with liver disease completed the study. Median (±interquartile range) normalized measurable liver areas were 62.6% (±26.4%) and 44.1% (±39.6%) for scan 1, and 60.3% (±21.8%) and 43.9% (±44.2%) for scan 2, for Cartesian and radial techniques, respectively. Hepatic stiffness from the Cartesian and radial techniques had close agreement with CCC of 0.89 and 0.94, and mean difference of 0.03 kPa and -0.01 kPa, for scans 1 and 2. Cartesian and radial techniques achieved similar repeatability with within-subject coefficient of variation=1.9% and 3.4%, and ICC=0.93 and 0.92, respectively. CONCLUSION In this pilot study, radial free-breathing MR elastography was repeatable and in agreement with Cartesian breath-hold MR elastography in children.
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Affiliation(s)
- Sevgi Gokce Kafali
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA 90095 USA ,Department of Bioengineering, University of California Los Angeles, Los Angeles, CA USA
| | - Tess Armstrong
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA 90095 USA
| | - Shu-Fu Shih
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA 90095 USA ,Department of Bioengineering, University of California Los Angeles, Los Angeles, CA USA
| | - Grace J. Kim
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA 90095 USA
| | - Joseph L. Holtrop
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN USA
| | - Robert S. Venick
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
| | - Shahnaz Ghahremani
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA 90095 USA
| | | | - Claudia M. Hillenbrand
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN USA ,Research Imaging NSW, University of New South Wales, Sydney, Australia
| | - Kara L. Calkins
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
| | - Holden H. Wu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA 90095 USA ,Department of Bioengineering, University of California Los Angeles, Los Angeles, CA USA
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Lorton O, Toso S, El-Begri Talbi H, Anooshiravani M, Poletti PA, Hanquinet S, Salomir R. A tailored passive driver for liver MRE in pediatric patients. Front Pediatr 2022; 10:999830. [PMID: 36568430 PMCID: PMC9768363 DOI: 10.3389/fped.2022.999830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives Magnetic resonance elastography (MRE) is increasingly used in the pediatric population for diagnosis and staging of liver fibrosis. However, the MR-compatible driver and sequences are usually those used for adult patients. Our feasibility study aimed to adapt the standardized adult MRE passive driver and vibrational parameters to a pediatric population. Methods We designed an elliptic passive driver shaped on a torus equipped with an elastic membrane and adapted to children's morphologies. As a first step, eight children (aged 8-18 years) were enrolled in a prospective pilot study aiming to determine the threshold vibrational amplitude for MRE using a custom passive driver, based on phase aliasing assessment and the occurrence of signal void artifacts on magnitude MR images. In the second step, the practicality and the consistency of the custom driver were assessed in a further 11 pediatric patients (aged 7-18 years). In the third step, we compared our custom driver vs. the commercial driver on six adult volunteers, in terms of the reliable region of interest area within the acquired MRE slices, the shear wave maps' quality, and measured stiffness values obtained. Results Based on pediatric patient data, the threshold vibrational amplitude expressed as percentage of maximum output was found to be 0.4 and 1.1 times the body weight (kg) at 40 and 60 Hz frequencies, respectively. In comparison to the commercial passive driver, the custom driver improved threefold the contact with the body surface, also enabling a more comfortable examination as self-assessed by the volunteers. Conclusions Our custom driver was more comfortable for the volunteers and was able to generate more homogenous shear waves, yielding larger usable hepatic area, and more reliable stiffness values.
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Affiliation(s)
- Orane Lorton
- Image Guided Interventions Laboratory (GR 949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Radiology Division, University Hospitals of Geneva, Geneva, Switzerland
- Correspondence: Orane Lorton
| | - Seema Toso
- Unit of Pediatric Radiology, Radiology Division, University Hospitals of Geneva, Geneva, Switzerland
| | - Hayat El-Begri Talbi
- Unit of Pediatric Radiology, Radiology Division, University Hospitals of Geneva, Geneva, Switzerland
| | - Mehrak Anooshiravani
- Unit of Pediatric Radiology, Radiology Division, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Sylviane Hanquinet
- Unit of Pediatric Radiology, Radiology Division, University Hospitals of Geneva, Geneva, Switzerland
| | - Rares Salomir
- Image Guided Interventions Laboratory (GR 949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Radiology Division, University Hospitals of Geneva, Geneva, Switzerland
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Elsingergy MM, Carlsson T, Andronikou S. Evaluation of quality of renal tract ultrasound scans and reports performed in children with first urinary tract infection. J Med Imaging Radiat Sci 2021; 53:65-74. [PMID: 34893454 DOI: 10.1016/j.jmir.2021.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/16/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine the quality of renal tract ultrasound (US) imaging records performed in children for evaluation of urinary tract infection (UTI) by multiple professionals with different levels of experience in a dedicated academic children's hospital. METHODS Retrospective analysis of US images and reports for children ≤ 13-years with first presentation of a UTI. 9 Operators (6 consultant radiologists and 3 sonographers) were anonymised and the adequacy of their US images and reports were evaluated for the following categories; Image acquisition, Image labelling, Metric labelling, and Final reporting. The frequency of the reporting quality of the elements assessed was compared between radiologists and sonographers using Chi-square or fisher exact test. RESULTS Renal tract US studies for 100 children (20 males, 80 females) with first UTI episode were assessed. Mean age was 4.5 ± 3.4 years. 54% of the studies were performed by sonographers and 46% by radiologists. Kidneys and pre-micturition bladder scans were acquired in more than 96% of exams by both sonographers and radiologists. Kidney image and metric labelling was adequate in almost all exams (98-100%) with the exception of plane labelling which was not routinely done by US operators (less than 3%). Sonographers performed consistently better than radiologists in post-micturition bladder scanning, pre- and post-micturition bladder labelling and renal length reporting (p<0.05). Least to be recorded by US operators (both radiologists and sonographers) were doppler scan acquisitions (less than 3%), bladder wall thickness labelling (less than 3%), and renal calculi reporting (less than 1%). CONCLUSION The inconsistency of the reporting quality between the different elements assessed highlights the difference in US training and experience received by sonographers and radiologists. A pro-forma structured reporting template may ensure US operators provide consistent, thorough and good quality ultrasound images and reports.
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Affiliation(s)
- Mohamed M Elsingergy
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
| | - Tarryn Carlsson
- Department of Radiology, Bristol Royal Hospital for Children, University Hospitals Bristol, Bristol, United States
| | - Savvas Andronikou
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Department of Radiology, Bristol Royal Hospital for Children, University Hospitals Bristol, Bristol, United States; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
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Ghosh A, Serai SD, Venkatakrishna SSB, Dutt M, Hartung EA. Two-dimensional (2D) morphologic measurements can quantify the severity of liver disease in children with autosomal recessive polycystic kidney disease (ARPKD). Abdom Radiol (NY) 2021; 46:4709-4719. [PMID: 34173844 DOI: 10.1007/s00261-021-03189-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/18/2021] [Accepted: 06/18/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the correlation of 2D shape-based features with magnetic resonance elastography (MRE)-derived liver stiffness and portal hypertension (pHTN) in children with ARPKD-associated congenital hepatic fibrosis. METHODS In a prospective IRB-approved study, 14 children with ARPKD (mean age ± SD = 13.8 ± 5.8 years) and 14 healthy controls (mean age ± SD = 13.7 ± 3.9 years) underwent liver MRE. A 2D region of interest (ROI) outlining the left liver lobe at the level of the abdominal aorta was drawn on sagittal T2-weighted images. Eight shape features (perimeter, major axis length, maximum diameter, perimeter to surface ratio (PSR), elongation, sphericity, minor axis length, and mesh surface) describing the 2D-ROI were calculated. Spearman's correlation was calculated between shape features and MRE-derived liver stiffness (kPa) (n = 28). Shape features were compared between participants with ARPKD with pHTN (splenomegaly and thrombocytopenia), (n = 4) and without pHTN (n = 8) using the Mann Whitney U test. Receiver operating characteristic (ROC) curves were generated to examine the diagnostic accuracy of shape features in identifying cases with liver stiffness > 2.9 kPa. RESULTS In ARPKD participants and healthy controls, all eight shape features, except elongation, showed moderate to strong correlation with liver stiffness (kPa); the perimeter surface ratio had the strongest correlation (rho = - 0.75, p < 0.001). In ROC analysis, a cut-off of PSR ≤ 0.057 mm-1 gave 100% (95% CI: 59.0-100.0) sensitivity and 100% (95% CI: 83.9-100.0) specificity in identifying ARPKD participants with liver stiffness > 2.9 kPa, with an area under the ROC curve (AUC) of 1.0 (95% CI: 0.88-1.00). Individuals with pHTN had a lower median PSR (mean ± SD = 0.05 ± 0.01) than those without (0.07 ± 0.01; p = 0.027) with an AUC of 0.91 (95% CI: 0.60-0.99) in differentiating the participants with and without pHTN. CONCLUSION Shape-based features of the left liver lobe show potential as non-invasive biomarkers of liver fibrosis and portal hypertension in children with ARPKD.
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Effect of different driver power amplitudes on liver stiffness measurement in pediatric liver MR elastography. Abdom Radiol (NY) 2021; 46:4729-4735. [PMID: 34216244 DOI: 10.1007/s00261-021-03197-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE To assess how different driver power amplitudes affect the measurement of liver stiffness in pediatric liver magnetic resonance elastography (MRE). METHODS From January 2018 to May 2018, pediatric patients (≤ 18 years) who underwent liver MRE with 20% and 56% driver power amplitudes were included in this retrospective study. Region-of-interests (ROIs) were drawn on four stiffness maps to include the largest area of the liver parenchyma. Intraclass correlation coefficients (ICCs) were used to assess agreements for the area, mean, maximum, minimum and standard deviation of liver stiffness between the driver power amplitudes. RESULTS 128 MRE stiffness maps from 16 patients (M:F = 10:6, median 12.5 years old) were included. On MRE, median ROI areas of liver were 83.1 cm2 (range, 46.9-144.1 cm2) and 63.0 cm2 (range, 5.4-123.4 cm2) for the driver power amplitudes of 20% and 56%, respectively. Median liver stiffness values were 2.3 kPa (range, 1.7-8.0 kPa) and 2.8 kPa (range, 1.7-8.5 kPa). Maximum and minimum liver stiffness values were 5.3 kPa and 1.0 kPa for 20% and 7.8 kPa and 1.1 kPa for 56%. Standard deviation was 0.6 kPa for 20% and 1.0 kPa for 56%. ICC values between the two power amplitudes were 0.33-0.51 for the ROI area and the maximum, minimum and standard deviation values of liver stiffness. The ICC value for liver stiffness was 0.857 (95% confidence interval, 0.760-0.915). CONCLUSION Liver stiffness with two driver power amplitudes on MRE showed good reliability in pediatric patients. Driver power amplitudes need to be optimized according to the pediatric liver size.
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Yang JY, Qiu BS. The Advance of Magnetic Resonance Elastography in Tumor Diagnosis. Front Oncol 2021; 11:722703. [PMID: 34532290 PMCID: PMC8438294 DOI: 10.3389/fonc.2021.722703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/04/2021] [Indexed: 11/13/2022] Open
Abstract
The change in tissue stiffness caused by pathological changes in the tissue's structure could be detected earlier, prior to the manifestation of their clinical features. Magnetic resonance elastography (MRE) is a noninvasive imaging technique that uses low-frequency vibrations to quantitatively measure the elasticity or stiffness of tissues. In tumor tissue, stiffness is directly related to tumor development, invasion, metastasis, and chemoradiotherapy resistance. It also dictates the choice of surgical method. At present, MRE is widely used in assessing different human organs, such as the liver, brain, breast, prostate, uterus, gallbladder, and colon stiffness. In the field of oncology, MRE's value lies in tumor diagnosis (especially early diagnosis), selection of treatment method, and prognosis evaluation. This article summarizes the principle of MRE and its research and application progress in tumor diagnosis and treatment.
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Affiliation(s)
- Jin-Ying Yang
- Laboratory Center for Information Science, University of Science and Technology of China, Hefei, China
| | - Ben-Sheng Qiu
- Hefei National Lab for Physical Sciences at the Microscale and the Centers for Biomedical Engneering, University of Science and Technology of China, Hefei, China
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Serai SD, Panganiban J, Dhyani M, Degnan AJ, Anupindi SA. Imaging Modalities in Pediatric NAFLD. Clin Liver Dis (Hoboken) 2021; 17:200-208. [PMID: 33868666 PMCID: PMC8043697 DOI: 10.1002/cld.994] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/05/2020] [Accepted: 06/12/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Suraj D. Serai
- Department of RadiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA,Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaPA
| | - Jennifer Panganiban
- Department of Gastroenterology, Hepatology and NutritionThe Children's Hospital of PhiladelphiaPhiladelphiaPA
| | - Manish Dhyani
- Department of RadiologyLahey Hospital and Medical CenterBurlingtonMA
| | - Andrew J. Degnan
- Department of RadiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Sudha A. Anupindi
- Department of RadiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPA,Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaPA
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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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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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Krishnamurthy R, Thompson BL, Shankar A, Gariepy CE, Potter CJ, Fung BR, Hu HH. Magnetic Resonance Elastography of the Liver in Children and Adolescents: Assessment of Regional Variations in Stiffness. Acad Radiol 2020; 27:e109-e115. [PMID: 31412984 DOI: 10.1016/j.acra.2019.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/16/2019] [Accepted: 07/18/2019] [Indexed: 12/14/2022]
Abstract
RATIONALE AND OBJECTIVES We describe our experience in measuring parenchyma stiffness across the liver Couinaud segments in lieu of the conventional practice of using a single slice-wise "global" region-of-interest. We hypothesize that the heterogeneous nature of fibrosis can lead to regional stiffness within the organ, and that it can be reflected by Couinaud segment-based magnetic resonance elastography measurements. MATERIALS AND METHODS This retrospective study involved from 173 patients (116 males, 57 females, 1.0-22.5 years, 14.7 ± 3.5 years) who underwent exams between June 2017 and September 2018. Liver stiffness across the eight Couinaud segments was measured in addition to a single-slice global measurement by two analysts. Inter- and intrarater analysis was performed in a subset of 20 cases. Individual segment stiffness values, the average across the segments, and the coefficients of variation (CoV) were compared to global single-slice-derived values using linear and Lin's concordance correlation coefficients. Linear correlations between stiffness values versus age, gender, and body-mass-index (BMI) were also evaluated. RESULTS We observed CoVs ranging from 3.1%-79.2%, 17.2 ± 7.2%. The CoV was not correlated with age or BMI (r2 < 0.01, p = 0.99 for both). The CoV did not differ between males (17.1 ± 5.6%) and females (17.3 ± 9.8%) (p = 0.88). There were no correlations between global stiffness versus age (r2 = 0.02, p = 0.84) or BMI (r2 = 0.03, p = 0.68). A range of 0.58-0.86 was observed for Lin's concordance correlation coefficient between segmental stiffness, the average stiffness across segments, and global stiffness. Segments II and VII had the highest frequency of being the stiffest Couinaud segment. The average stiffness across the segments correlated strongly with the single-slice global measurement (r2 = 0.88, p< 0.01). CONCLUSION There exists potential variations in parenchyma stiffness across the liver Couinaud segments, which may reflect the heterogeneous nature of fibrosis. This variation can potentially provide additional diagnostic and clinical information.
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Affiliation(s)
- Ramkumar Krishnamurthy
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205
| | - Benjamin L Thompson
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205
| | - Anand Shankar
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205
| | - Cheryl E Gariepy
- Department of Gastroenterology and Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, Ohio
| | - Carol J Potter
- Department of Gastroenterology and Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, Ohio
| | - Bonita R Fung
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Houchun H Hu
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205.
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Newly Developed Methods for Reducing Motion Artifacts in Pediatric Abdominal MRI: Tips and Pearls. AJR Am J Roentgenol 2020; 214:1042-1053. [PMID: 32023117 DOI: 10.2214/ajr.19.21987] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE. The purpose of this article is to review established and emerging methods for reducing motion artifacts in pediatric abdominal MRI. CONCLUSION. Clearly understanding the strengths and limitations of motion reduction methods can enable practitioners of pediatric abdominal MRI to select and combine the appropriate techniques and potentially reduce the need for sedation and anesthesia.
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