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Mai XF, Zhang H, Wang Y, Zhong WX, Zou LQ. Multiparametric MRI-based whole-liver radiomics for predicting early-stage liver fibrosis in rabbits. Br J Radiol 2024; 97:964-970. [PMID: 38552321 DOI: 10.1093/bjr/tqae063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/26/2024] [Accepted: 03/18/2024] [Indexed: 05/09/2024] Open
Abstract
OBJECTIVES To develop and validate a whole-liver radiomic model using multiparametric MRI for predicting early-stage liver fibrosis (LF) in rabbits. METHODS A total of 134 rabbits (early-stage LF, n = 91; advanced-stage LF, n = 43) who underwent liver magnetic resonance elastography (MRE), hepatobiliary phase, dynamic contrast enhanced (DCE), intravoxel incoherent motion (IVIM), diffusion kurtosis imaging, and T2* scanning were enrolled and randomly allocated to either the training or validation cohort. Whole-liver radiomic features were extracted and selected to develop a radiomic model and generate quantitative Rad-scores. Then, multivariable logistic regression was utilized to determine the Rad-scores associated with early-stage LF, and effective features were integrated to establish a combined model. The predictive performance was assessed by the area under the curve (AUC). RESULTS The MRE model achieved superior AUCs of 0.95 in the training cohort and 0.86 in the validation cohort, followed by the DCE-MRI model (0.93 and 0.82), while the IVIM model had lower AUC values of 0.91 and 0.82, respectively. The Rad-scores of MRE, DCE-MRI and IVIM were identified as independent predictors associated with early-stage LF. The combined model demonstrated AUC values of 0.96 and 0.88 for predicting early-stage LF in the training and validation cohorts, respectively. CONCLUSIONS Our study highlights the remarkable performance of a multiparametric MRI-based radiomic model for the individualized diagnosis of early-stage LF. ADVANCES IN KNOWLEDGE This is the first study to develop a combined model by integrating multiparametric radiomic features to improve the accuracy of LF staging.
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Affiliation(s)
- Xiao-Fei Mai
- Department of Radiology, Sixth Affiliated Hospital of Shenzhen University, Shenzhen 518052, China
| | - Hao Zhang
- Department of Radiology, Sixth Affiliated Hospital of Shenzhen University, Shenzhen 518052, China
| | - Yang Wang
- Department of Radiology, Sixth Affiliated Hospital of Shenzhen University, Shenzhen 518052, China
| | - Wen-Xin Zhong
- Department of Radiology, Sixth Affiliated Hospital of Shenzhen University, Shenzhen 518052, China
| | - Li-Qiu Zou
- Department of Radiology, Sixth Affiliated Hospital of Shenzhen University, Shenzhen 518052, China
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Liu J, Huang M, Zhang Y, Yao F, Zhang X, Yin M, Wang K, Cheng J. Technical Success and Reliability of Magnetic Resonance Elastography in Patients with Hepatic Iron Overload. Acad Radiol 2024; 31:1326-1335. [PMID: 37863778 DOI: 10.1016/j.acra.2023.08.016] [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: 06/14/2023] [Revised: 08/03/2023] [Accepted: 08/14/2023] [Indexed: 10/22/2023]
Abstract
RATIONALE AND OBJECTIVES This study aimed to evaluate the technical success rate and stiffness measurement reliability of two specific hepatic magnetic resonance elastography (MRE) sequences dedicated to solving susceptibility artifacts in patients with various degrees of hepatic iron overload. MATERIALS AND METHODS Thirty-seven patients with iron-overloaded liver confirmed by R2* value measurement who underwent two-dimensional (2D) spin-echo (SE) MRE and 2D SE-echo-planar-imaging (EPI) MRE were reviewed retrospectively. According to four categories based on R2* value (mild, moderate, severe elevation, and extremely severe iron overload), we compared the success rate, quality score, and liver stiffness of the two sequences. In addition, Spearman's correlation was performed to evaluate the relationship between the R2* value and liver stiffness. RESULTS The overall success rates of SE MRE and SE-EPI MRE in patients with hepatic iron overload were 91.89% and 78.38%, respectively, and 100% and 78.57%, respectively, for severe elevation iron overload. In all patients, the MRE quality scores were 54 and 48 for SE MRE and SE-EPI MRE, respectively (P = 0.107). There were no significant differences in liver stiffness measurements between the two MRE methods in patients with mild, moderate, and severe elevation iron-overloaded livers (P > 0.6 for all), respectively. For both MRE methods, R2* value had no significant effect on the liver stiffness measurements (correlation coefficient <0.1, P >0.6 for both). CONCLUSION In the mild and moderate elevation iron-overloaded liver, both SE MRE and fast SE-EPI MRE can provide successful and reliable liver stiffness measurement. In severe elevation iron-overloaded livers, SE MRE may be a better choice than SE-EPI MRE.
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Affiliation(s)
- Jingjing Liu
- Department of MR Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (J.L., M.H., Y.Z., F.Y., X.Z., J.C.).
| | - Mengyue Huang
- Department of MR Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (J.L., M.H., Y.Z., F.Y., X.Z., J.C.)
| | - Yong Zhang
- Department of MR Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (J.L., M.H., Y.Z., F.Y., X.Z., J.C.)
| | - Feifei Yao
- Department of MR Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (J.L., M.H., Y.Z., F.Y., X.Z., J.C.)
| | - Xiaopan Zhang
- Department of MR Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (J.L., M.H., Y.Z., F.Y., X.Z., J.C.)
| | - Meng Yin
- Department of Radiology, Mayo Clinic, Rochester, Minnesota (M.Y.)
| | - Kaiyu Wang
- MR Research China, GE Healthcare, Beijing, PR China (K.W.)
| | - Jingliang Cheng
- Department of MR Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (J.L., M.H., Y.Z., F.Y., X.Z., J.C.)
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Xiao L, Zhao H, Liu S, Dong W, Gao Y, Wang L, Huang B, Li Z. Staging liver fibrosis: comparison of radiomics model and fusion model based on multiparametric MRI in patients with chronic liver disease. Abdom Radiol (NY) 2024; 49:1165-1174. [PMID: 38219254 DOI: 10.1007/s00261-023-04142-2] [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: 09/25/2023] [Revised: 11/15/2023] [Accepted: 11/22/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVES To develop and compare radiomics model and fusion model based on multiple MR parameters for staging liver fibrosis in patients with chronic liver disease. MATERIALS AND METHODS Patients with chronic liver disease who underwent multiparametric abdominal MRI were included in this retrospective study. Multiparametric MR images were imported into 3D-Slicer software for drawing bounding boxes on MR images. By using a 3D-Slicer extension of SlicerRadiomics, radiomics features were extracted from these MR images. The z-score normalization method was used for post-processing radiomics features. The least absolute shrinkage and selection operator method (LASSO) was performed for selecting significant radiomics features. The logistic regression analysis was used for building the radiomics model. A fusion model was built by integrating serum fibrosis biomarkers of aspartate transaminase-to-platelet ratio index (APRI) and the fibrosis-4 index (FIB-4) with radiomics signatures. RESULTS In the training cohort, AUCs of radiomics and fusion model were 0.707-0.842 and 0.718-0.854 for differentiating different groups. In the testing cohort, AUCs were 0.514-0.724 and 0.609-0.728. For the training cohort, there was no significant difference of AUCs between radiomics and fusion model (p > 0.05). For the testing cohort, AUCs of fusion model were higher than those of radiomics model in differentiating F1-3 vs. F4 and F1-2 vs. F4 (p = 0.011 & 0.042). CONCLUSIONS Radiomics model and fusion model based on multiparametric MRI exhibited the feasibility for staging liver fibrosis in patients with CLD, and APRI and FIB-4 could improve the diagnostic performance of radiomics model in differentiating F1-3 vs. F4 and F1-2 vs. F4.
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Affiliation(s)
- Longyang Xiao
- Department of Radiology, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, China
| | - Haichen Zhao
- Department of Radiology, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, China
| | - Shunli Liu
- Department of Radiology, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, China
| | - Wenlu Dong
- Department of Radiology, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, China
| | - Yuanxiang Gao
- Department of Radiology, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, China
| | - Lili Wang
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Baoxiang Huang
- College of Computer Science and Technology of Qingdao University, No.308 Ningxia Road, Qingdao, 266071, China.
| | - Zhiming Li
- Department of Radiology, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, China.
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Wang R, Wang Y, Qiu S, Ma S, Yan F, Yang GZ, Li R, Feng Y. A Comparative Study of Three Systems for Liver Magnetic Resonance Elastography. J Magn Reson Imaging 2024. [PMID: 38449389 DOI: 10.1002/jmri.29335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Different MR elastography (MRE) systems may produce different stiffness measurements, making direct comparison difficult in multi-center investigations. PURPOSE To assess the repeatability and reproducibility of liver stiffness measured by three typical MRE systems. STUDY TYPE Prospective. POPULATION/PHANTOMS Thirty volunteers without liver disease history (20 males, aged 21-28)/5 gel phantoms. FIELD STRENGTH/SEQUENCE 3.0 T United Imaging Healthcare (UIH), 1.5 T Siemens Healthcare, 3.0 T General Electric Healthcare (GE)/Echo planar imaging-based MRE sequence. ASSESSMENT Wave images of volunteers and phantoms were acquired by three MRE systems. Tissue stiffness was evaluated by two observers, while phantom stiffness was assessed automatically by code. The reproducibility across three MRE systems was quantified based on the mean stiffness of each volunteer and phantom. STATISTICAL TESTS Intraclass correlation coefficients (ICC), coefficients of variation (CV), and Bland-Altman analyses were used to assess the interobserver reproducibility, the interscan repeatability, and the intersystem reproducibility. Paired t-tests were performed to assess the interobserver and interscan variation. Friedman tests with Dunn's multiple comparison correction were performed to assess the intersystem variation. P values less than 0.05 indicated significant difference. RESULTS The reproducibility of stiffness measured by the two observers demonstrated consistency with ICC > 0.92, CV < 4.32%, Mean bias < 2.23%, and P > 0.06. The repeatability of measurements obtained using the electromagnetic system for the liver revealed ICC > 0.96, CV < 3.86%, Mean bias < 0.19%, P > 0.90. When considering the range of reproducibility across the three systems for liver evaluations, results ranged with ICCs from 0.70 to 0.87, CVs from 6.46% to 10.99%, and Mean biases between 1.89% and 6.30%. Phantom studies showed similar results. The values of measured stiffness differed across all three systems significantly. DATA CONCLUSION Liver stiffness values measured from different MRE systems can be different, but the measurements across the three MRE systems produced consistent results with excellent reproducibility. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Runke Wang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
- National Engineering Research Center of Advanced Magnetic Resonance Technologies for Diagnosis and Therapy (NERC-AMRT), Shanghai Jiao Tong University, Shanghai, China
| | - Yikun Wang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Faculty of Medical Imaging Technology, College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Suhao Qiu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
- National Engineering Research Center of Advanced Magnetic Resonance Technologies for Diagnosis and Therapy (NERC-AMRT), Shanghai Jiao Tong University, Shanghai, China
| | - Shengyuan Ma
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
- National Engineering Research Center of Advanced Magnetic Resonance Technologies for Diagnosis and Therapy (NERC-AMRT), Shanghai Jiao Tong University, Shanghai, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Faculty of Medical Imaging Technology, College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guang-Zhong Yang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
- National Engineering Research Center of Advanced Magnetic Resonance Technologies for Diagnosis and Therapy (NERC-AMRT), Shanghai Jiao Tong University, Shanghai, China
| | - Ruokun Li
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Faculty of Medical Imaging Technology, College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Feng
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
- National Engineering Research Center of Advanced Magnetic Resonance Technologies for Diagnosis and Therapy (NERC-AMRT), Shanghai Jiao Tong University, Shanghai, China
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Sebro R. Advancing Diagnostics and Patient Care: The Role of Biomarkers in Radiology. Semin Musculoskelet Radiol 2024; 28:3-13. [PMID: 38330966 DOI: 10.1055/s-0043-1776426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
The integration of biomarkers into medical practice has revolutionized the field of radiology, allowing for enhanced diagnostic accuracy, personalized treatment strategies, and improved patient care outcomes. This review offers radiologists a comprehensive understanding of the diverse applications of biomarkers in medicine. By elucidating the fundamental concepts, challenges, and recent advancements in biomarker utilization, it will serve as a bridge between the disciplines of radiology and epidemiology. Through an exploration of various biomarker types, such as imaging biomarkers, molecular biomarkers, and genetic markers, I outline their roles in disease detection, prognosis prediction, and therapeutic monitoring. I also discuss the significance of robust study designs, blinding, power and sample size calculations, performance metrics, and statistical methodologies in biomarker research. By fostering collaboration between radiologists, statisticians, and epidemiologists, I hope to accelerate the translation of biomarker discoveries into clinical practice, ultimately leading to improved patient care.
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Affiliation(s)
- Ronnie Sebro
- Department of Radiology, Center for Augmented Intelligence, Mayo Clinic, Jacksonville, Florida
- Department of Biostatistics, Center for Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida
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Bhuiyan EH, Ozkaya E, Kennedy P, Del Hoyo JL, Achkar BE, Thung S, Lewis S, Bane O, Taouli B. Magnetic resonance elastography for noninvasive detection of liver fibrosis: is there an added value of 3D acquisition? Abdom Radiol (NY) 2023; 48:3420-3429. [PMID: 37700185 DOI: 10.1007/s00261-023-04036-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE (1) Assess the diagnostic performance of liver 3D magnetic resonance elastography (MRE) parameters (including stiffness, storage/loss modulus and damping ratio) compared to liver stiffness measured with 2D MRE for noninvasive detection of advanced liver fibrosis (F3-F4) and cirrhosis (F4) in patients with chronic liver disease. (2) Assess the value of serum markers (FIB-4) in detecting advanced liver fibrosis and cirrhosis in the same patients. METHODS This was a single center, prospective IRB-approved cross-sectional study that included 49 patients (M/F: 23/26, mean age 50.8 y) with chronic liver disease and concomitant liver biopsy. MRE was acquired at 1.5T using a spin echo-EPI sequence. The following parameters were measured: liver stiffness using 2D MRE (LS-2D) and 3D MRE parameters (LS-3D, liver storage, loss modulus and damping ratio). The Mann-Whitney U test, ROC curve analysis, Spearman correlation and logistic regression were performed to evaluate diagnostic performance of MRE parameters and FIB-4. RESULTS LS-2D and LS-3D had similar diagnostic performance for diagnosis of F3-F4, with AUCs of 0.87 and 0.88, sensitivity of 0.71 and 0.81, specificity of 0.89 for both. For diagnosis of F4, LS-2D and LS-3D had similar performance with AUCs of 0.81 for both, sensitivity of 0.75 and 0.83, and specificity of 0.84 and 0.73, respectively. Additional 3D parameters (storage modulus, loss modulus, damping ratio) had variable performance, with AUC range of 0.59-0.78 for F3-F4; and 0.52-0.70 for F4. FIB-4 had lower diagnostic performance, with AUCs of 0.66 for F3-F4, and 0.68 for F4. CONCLUSION Our study shows no added value of 3D MRE compared to 2D MRE for detection of advanced fibrosis and cirrhosis, while FIB-4 had lower diagnostic performance.
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Affiliation(s)
- Enamul H Bhuiyan
- BioMedical Engineering and Imaging Institute (BMEII), Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Efe Ozkaya
- BioMedical Engineering and Imaging Institute (BMEII), Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul Kennedy
- BioMedical Engineering and Imaging Institute (BMEII), Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Juan Lloret Del Hoyo
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Bassam El Achkar
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Swan Thung
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sara Lewis
- BioMedical Engineering and Imaging Institute (BMEII), Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Octavia Bane
- BioMedical Engineering and Imaging Institute (BMEII), Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bachir Taouli
- BioMedical Engineering and Imaging Institute (BMEII), Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Jang W, Jo S, Song JS, Hwang HP, Kim SH. Correction to: Comparison of diffusion‑weighted imaging and MR elastography in staging liver fibrosis: a meta‑analysis. Abdom Radiol (NY) 2023; 48:2763-2768. [PMID: 37231220 DOI: 10.1007/s00261-023-03942-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Weon Jang
- Department of Radiology, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea
- Biomedical Research Institute of Jeonbuk National University Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, Jeonbuk, 54907, Korea
| | - Seongil Jo
- Department of Statistics, Inha University, Incheon, Korea
| | - Ji Soo Song
- Department of Radiology, Jeonbuk National University Medical School and Hospital, Jeonju, Korea.
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea.
- Biomedical Research Institute of Jeonbuk National University Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, Jeonbuk, 54907, Korea.
| | - Hong Pil Hwang
- Department of Surgery, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Seong-Hun Kim
- Department of Internal Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
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Armandi A, Michel M, Gjini K, Emrich T, Bugianesi E, Schattenberg JM. Emerging concepts in the detection of liver fibrosis in non-alcoholic fatty liver disease. Expert Rev Mol Diagn 2023; 23:771-782. [PMID: 37505901 DOI: 10.1080/14737159.2023.2242779] [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: 04/06/2023] [Revised: 06/24/2023] [Accepted: 07/27/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION The non-invasive identification of liver fibrosis related to Non-Alcoholic Fatty Liver Disease is crucial for risk-stratification of patients. Currently, the reference standard to stage hepatic fibrosis relies on liver biopsy, but multiple approaches are developed to allow for non-invasive diagnosis and risk stratification. Non-invasive tests, including blood-based scores and vibration-controlled transient elastography, have been widely validated and represent a good surrogate for risk stratification according to recent European and American guidelines. AREAS COVERED Novel approaches are based on 'liquid' biomarkers of liver fibrogenesis, including collagen-derived markers (PRO-C3 or PRO-C6), or 'multi-omics' technologies (e.g. proteomic-based molecules or miRNA testing), bearing the advantage of tailoring the intrahepatic disease activity. Alternative approaches are based on 'dry' biomarkers, including magnetic resonance-based tools (including proton density fat fraction, magnetic resonance elastography, or corrected T1), which reach similar accuracy of liver histology and will potentially help identify the best candidates for pharmacological treatment of fibrosing non-alcoholic steatohepatitis. EXPERT OPINION In the near future, the sequential use of non-invasive tests, as well as the complimentary use of liquid and dry biomarkers according to the clinical need (diagnosis, risk stratification, and prognosis, or treatment response) will guide and improve the management of this liver disease.
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Affiliation(s)
- Angelo Armandi
- Division of Gastroenterology and Hepatology, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy
- Metabolic Liver Research Program, I. Department of Medicine, University Medical Centre Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Maurice Michel
- Metabolic Liver Research Program, I. Department of Medicine, University Medical Centre Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
- I. Department of Medicine, University Medical Centre Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Kamela Gjini
- Division of Gastroenterology and Hepatology, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy
| | - Tilman Emrich
- Department of Radiology, University Medical Centre Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Elisabetta Bugianesi
- Division of Gastroenterology and Hepatology, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy
| | - Jorn M Schattenberg
- Metabolic Liver Research Program, I. Department of Medicine, University Medical Centre Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
- I. Department of Medicine, University Medical Centre Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
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Zheng S, He K, Zhang L, Li M, Zhang H, Gao P. Conventional and artificial intelligence-based computed tomography and magnetic resonance imaging quantitative techniques for non-invasive liver fibrosis staging. Eur J Radiol 2023; 165:110912. [PMID: 37290363 DOI: 10.1016/j.ejrad.2023.110912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023]
Abstract
Chronic liver disease (CLD) ultimately develops into liver fibrosis and cirrhosis and is a major public health problem globally. The assessment of liver fibrosis is important for patients with CLD for prognostication, treatment decisions, and surveillance. Liver biopsies are traditionally performed to determine the stage of liver fibrosis. However, the risks of complications and technical limitations restrict their application to screening and sequential monitoring in clinical practice. CT and MRI are essential for evaluating cirrhosis-associated complications in patients with CLD, and several non-invasive methods based on them have been proposed. Artificial intelligence (AI) techniques have also been applied to stage liver fibrosis. This review aimed to explore the values of conventional and AI-based CT and MRI quantitative techniques for non-invasive liver fibrosis staging and summarized their diagnostic performance, advantages, and limitations.
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Affiliation(s)
- Shuang Zheng
- Department of Radiology, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, Jilin, China.
| | - Kan He
- Department of Radiology, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, Jilin, China.
| | - Lei Zhang
- Department of Radiology, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, Jilin, China.
| | - Mingyang Li
- Department of Radiology, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, Jilin, China.
| | - Huimao Zhang
- Department of Radiology, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, Jilin, China.
| | - Pujun Gao
- Department of Hepatology, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, Jilin, China.
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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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Ehman RL. Magnetic resonance elastography: from invention to standard of care. Abdom Radiol (NY) 2022; 47:3028-3036. [PMID: 35852570 PMCID: PMC9538645 DOI: 10.1007/s00261-022-03597-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 01/18/2023]
Abstract
In 1995, a vivid image of diffracting waves in red and blue was published on the cover of the journal SCIENCE. An article in that issue described a new imaging technology called magnetic resonance elastography (MRE) (Muthupillai in Science 269:1854-1857, 1995). In 2004, quantitative images of liver stiffness in vivo, obtained with MRE, were demonstrated for the first time at the annual meeting of the International Society for Magnetic Resonance in Medicine. Only five years later, the technology had become widely available as an FDA-cleared diagnostic tool for patient care. MRE has emerged as a reliable non-invasive diagnostic method for detecting and staging liver fibrosis. Deployed on more than 2000 MRI systems worldwide, MRE has received a Category I CPT code from the American Medical Association, based on clinical availability and efficacy. For many patients, MRE now provides a safe, more comfortable, and much less expensive alternative to liver biopsy for diagnosing liver fibrosis. Although progress in radiology is notable for a history of very rapid translation of technology innovations to patient care, the path is rarely linear. This article reflects on the story of MRE, the advances and the setbacks, and the lessons that were learned in the process.
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12
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Im WH, Song JS, Jang W. Noninvasive staging of liver fibrosis: review of current quantitative CT and MRI-based techniques. Abdom Radiol (NY) 2022; 47:3051-3067. [PMID: 34228199 DOI: 10.1007/s00261-021-03181-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 01/18/2023]
Abstract
Liver fibrosis features excessive protein accumulation in the liver interstitial space resulting from repeated tissue injury due to chronic liver disease. Liver fibrosis eventually proceeds to cirrhosis and associated complications. So, early diagnosis and staging of liver fibrosis are of vital importance for clinical treatment. Liver biopsy remains the gold standard for the diagnosing and staging of fibrosis, but it is suboptimal due to various limitations. Recently, efforts have been made to migrate toward noninvasive techniques for assessing liver fibrosis. CT is relatively easy to perform, relatively standardized for different scanners, and does not require additional hardware in liver fibrosis staging. MRI is frequently performed to characterize indeterminate liver lesions. Because it does not use ionizing radiation and features high image contrast, its role has increased in the staging of liver fibrosis. More recently, several studies on liver fibrosis staging using deep learning algorithms in CT or MRI have been proposed and have shown meaningful results. In this review, we summarize the basic concept, diagnostic performance, and advantages and limitations of each technique to noninvasively stage liver fibrosis.
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Affiliation(s)
- Won Hyeong Im
- Department of Radiology, The 3rd Flying Training Wing, Sacheon, 52516, South Korea
| | - Ji Soo Song
- Department of Radiology, Jeonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, 54907, Jeonbuk, South Korea.
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, South Korea.
- Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea.
| | - Weon Jang
- Department of Radiology, Jeonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, 54907, Jeonbuk, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, South Korea
- Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
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13
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Elkassem AA, Allen BC, Lirette ST, Cox KL, Remer EM, Pickhardt PJ, Lubner MG, Sirlin CB, Dondlinger T, Schmainda M, Jacobus RB, Severino PE, Smith AD. Multiinstitutional Evaluation of the Liver Surface Nodularity Score on CT for Staging Liver Fibrosis and Predicting Liver-Related Events in Patients With Hepatitis C. AJR Am J Roentgenol 2022; 218:833-845. [PMID: 34935403 DOI: 10.2214/ajr.21.27062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND. In single-institution multireader studies, the liver surface nodularity (LSN) score accurately detects advanced liver fibrosis and cirrhosis and predicts liver decompensation in patients with chronic liver disease (CLD) from hepatitis C virus (HCV). OBJECTIVE. The purpose of this study was to assess the diagnostic performance of the LSN score alone and in combination with the (FIB-4; fibrosis index based on four factors) to detect advanced fibrosis and cirrhosis and to predict future liver-related events in a multiinstitutional cohort of patients with CLD from HCV. METHODS. This retrospective study included 40 consecutive patients, from each of five academic medical centers, with CLD from HCV who underwent nontargeted liver biopsy within 6 months before or after abdominal CT. Clinical data were recorded in a secure web-based database. A single central reader measured LSN scores using software. Diagnostic performance for detecting liver fibrosis stage was determined. Multivariable models were constructed to predict baseline liver decompensation and future liver-related events. RESULTS. After exclusions, the study included 191 patients (67 women, 124 men; mean age, 54 years) with fibrosis stages of F0-F1 (n = 37), F2 (n = 44), F3 (n = 46), and F4 (n = 64). Mean LSN score increased with higher stages (F0-F1, 2.26 ± 0.44; F2, 2.35 ± 0.37; F3, 2.42 ± 0.38; F4, 3.19 ± 0.89; p < .001). The AUC of LSN score alone was 0.87 for detecting advanced fibrosis (≥ F3) and 0.89 for detecting cirrhosis (F4), increasing to 0.92 and 0.94, respectively, when combined with FIB-4 scores (both p = .005). Combined scores at optimal cutoff points yielded sensitivity of 75% and specificity of 82% for advanced fibrosis, and sensitivity of 84% and specificity of 85% for cirrhosis. In multivariable models, LSN score was the strongest predictor of baseline liver decompensation (odds ratio, 14.28 per 1-unit increase; p < .001) and future liver-related events (hazard ratio, 2.87 per 1-unit increase; p = .03). CONCLUSION. In a multiinstitutional cohort of patients with CLD from HCV, LSN score alone and in combination with FIB-4 score exhibited strong diagnostic performance in detecting advanced fibrosis and cirrhosis. LSN score also predicted future liver-related events. CLINICAL IMPACT. The LSN score warrants a role in clinical practice as a quantitative marker for detecting advanced liver fibrosis, compensated cirrhosis, and decompensated cirrhosis and for predicting future liver-related events in patients with CLD from HCV.
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Affiliation(s)
- Asser Abou Elkassem
- Department of Radiology, The University of Alabama at Birmingham, JTN 452, 619 19th St S, Birmingham, AL 35249
| | - Brian C Allen
- Department of Radiology, Duke University Medical Center, Durham, NC
| | - Seth T Lirette
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS
| | - Kelly L Cox
- Department of Radiology, Mayo Clinic, Jacksonville, FL
| | - Erick M Remer
- Department of Radiology, Cleveland Clinic Foundation, Cleveland, OH
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Claude B Sirlin
- Department of Radiology, Liver Imaging Group, University of California San Diego, San Diego, CA
| | | | | | | | | | - Andrew D Smith
- Department of Radiology, The University of Alabama at Birmingham, JTN 452, 619 19th St S, Birmingham, AL 35249
- AI Metrics, Birmingham, AL
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14
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Intra-patient comparison of 3D and 2D magnetic resonance elastography techniques for assessment of liver stiffness. Abdom Radiol (NY) 2022; 47:998-1008. [PMID: 34982182 DOI: 10.1007/s00261-021-03355-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate performance of 3D magnetic resonance elastography (MRE) using spin-echo echo-planar imaging (seEPI) for assessment of hepatic stiffness compared with 2D gradient-recalled echo (GRE) and 2D seEPI sequences. METHODS Fifty-seven liver MRE examinations including 2D GRE, 2D seEPI, and 3D seEPI sequences were retrospectively evaluated. Elastograms were analyzed by 2 radiologists and polygonal regions of interests (ROIs) were drawn in 2 different fashions: "curated" ROI (avoiding liver edge, major vessels, and areas of wave interferences) and "non-curated" ROI (including largest cross section of liver, to assess the contribution of artifacts). Liver stiffness measurement (LSM) was calculated as the arithmetic mean of individual stiffness values for each technique. For 3D MRE, LSMs were also calculated based on 4 slices ("abbreviated LSM"). Intra-patient variations in LSMs and different methods of ROI placement were assessed by univariate tests. A p-value of < 0.05 was set as a statistically significant difference. RESULTS Mean surface areas of the ROIs were 50,723 mm2, 12,669 mm2, 5814 mm2, and 10,642 mm2 for 3D MRE, abbreviated 3D MRE, 2D GRE, and 2D seEPI, respectively. 3D LSMs based on curated and non-curated ROIs showed no clinically significant difference, with a mean difference less than 0.1 kPa. Abbreviated 3D LSMs had excellent correlation with 3D LSMs based on all slices (r = 0.9; p < 0.001) and were not significantly different (p = 0.927). CONCLUSION 3D MRE allows more reproducible measurements due to its lower susceptibility to artifacts and provides larger areas of parenchyma, enabling a more comprehensive evaluation of the liver.
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15
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Lubert AM, Opotowsky AR, Palermo JJ, Alsaied T, Szugye C, Anwar N, Tiao GM, Lorts A, Dillman JR, Trout AT. Relation of Liver Volume to Adverse Cardiovascular Events in Adolescents and Adults With Fontan Circulation. Am J Cardiol 2022; 165:88-94. [PMID: 34893302 DOI: 10.1016/j.amjcard.2021.10.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/14/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022]
Abstract
Elevated central venous pressure in those with Fontan circulation causes liver congestion and hepatomegaly. We assessed if liver volume by magnetic resonance imaging (MRI) is associated with adverse cardiovascular outcomes. Retrospective study of 122 patients with Fontan circulation who were >10 years old and had a liver MRI with magnetic resonance elastography. Liver volume (ml) was measured by manual segmentation from axial T2-weighted images and was indexed to body surface area. The composite outcome included death, heart transplant, ventricular assist device placement, or nonelective cardiovascular hospitalization. The median age at the time of MRI was 18.9 (interquartile range 15.8 to 25.9) years, and 47% of the patients were women. The mean indexed liver volume was 1,133 ± 180 ml/m2. Indexed liver volume was not significantly associated with age, years since Fontan, or with liver stiffness (r = 0.15, p = 0.10), but was positively correlated with Fontan pressure (r = 0.32, p = 0.002). Over a median follow-up of 2.1 (0.8 to 4.2) years, 32 patients (26%) experienced the composite outcome. Higher indexed liver volume was associated with a greater hazard for the composite outcome (hazard ratio per 1 SD increase = 1.74, 95% confidence interval 1.27 to 2.35, p = 0.0004) but increased liver stiffness was not significantly associated with the composite outcome (hazard ratio per 1 SD increase 1.44, 95% confidence interval 0.90 to 2.21, p = 0.11). In conclusion, greater liver volume indexed to body surface area is associated with unfavorable hemodynamics and adverse outcomes in patients with Fontan circulation. Liver volume may be a useful, simple imaging biomarker in adolescents and adults with Fontan circulation.
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16
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Beyond the AJR: Prognostic Value of a Single Baseline Liver Stiffness Measurement by MR Elastography in Patients With Chronic Liver Disease. AJR Am J Roentgenol 2021; 219:169. [PMID: 34877871 DOI: 10.2214/ajr.21.27164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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17
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Brayer SW, Zafar F, Lubert AM, Trout AT, Palermo JJ, Opotowsky AR, Anwar N, Dillman JR, Alsaied T. Relation of Magnetic Resonance Elastography to Fontan Circulatory Failure in a Cohort of Pediatric and Adult Patients. Pediatr Cardiol 2021; 42:1871-1878. [PMID: 34448042 DOI: 10.1007/s00246-021-02707-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/04/2021] [Indexed: 01/03/2023]
Abstract
Elevated magnetic resonance elastography (MRE)-derived liver stiffness may be associated with worse outcomes in people with Fontan circulation. We sought to evaluate the association between liver stiffness and Fontan failure or portal hypertension. Single center cross-sectional retrospective study of people with Fontan circulation who underwent MRE between 2011 and 2020. The cohort was divided into adult (age ≥ 21 years) and pediatric (< 21 years) groups. Fontan circulatory failure (FF) was defined as any of the following: death, transplantation, ventricular assist device, heart failure symptoms requiring escalation of diuretics. Radiologic portal hypertension was defined as the presence of one or more of the following: splenomegaly, ascites, or gastrointestinal varices. 128 patients were included (average age = 22.6 ± 8.7 years) and 58 (45%) were children. Median liver stiffness was 4.3 kPa (interquartile range (IQR) 3.8-5.8) for the entire cohort. Thirty patients (23%) developed FF (16 adults, 14 children). Liver stiffness was higher in adults with FF compared to those without FF (4.9 (IQR 4.0-6.0) vs. 4.2 (IQR 3.8-4.7) kPa, p = 0.04). There was no difference in liver stiffness between pediatric patients with and without FF (4.4 (IQR 4.1-5.4) vs. 4.4 (IQR 3.8-5.0), p = 0.5). Adults with radiologic portal hypertension and adults with moderate or severe atrioventricular valve regurgitation had higher liver stiffness than adults without. MRE-derived liver stiffness is associated with atrioventricular valve regurgitation, portal hypertension, and poor clinical outcomes in adults with Fontan circulation. There was no association between liver stiffness and FF in pediatric patients. This difference may be due to the progressive nature of Fontan-associated liver disease.
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Affiliation(s)
- Samuel W Brayer
- Pediatric Residency Training Program, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, USA.
| | - Faizeen Zafar
- Pediatric Residency Training Program, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, USA
| | - Adam M Lubert
- Department of Pediatrics, Cincinnati Children's Hospital Heart Institute, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Joseph J Palermo
- Division of Gastroenterology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Alexander R Opotowsky
- Department of Pediatrics, Cincinnati Children's Hospital Heart Institute, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Nadeem Anwar
- Division of Gastroenterology, Department of Medicine, University of Cincinnati Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Tarek Alsaied
- UPMC Children's Hospital of Pittsburgh Heart and Vascular Institute, Pittsburgh, PA, USA
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18
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Clinical utility of 3D magnetic resonance elastography in patients with biliary obstruction. Eur Radiol 2021; 32:2050-2059. [PMID: 34791513 DOI: 10.1007/s00330-021-08295-w] [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: 06/02/2021] [Revised: 08/16/2021] [Accepted: 08/23/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Three-dimensional magnetic resonance elastography (3D-MRE) allows for multiparametric modeling of both elastic and viscous tissue characteristics. Our aim was to compare 3D-MRE with conventional liver shear stiffness assessment in gauging obstructive jaundice (OJ), predicting the adequacy of biliary decompression after drainage, and discriminating OJ from liver fibrosis. METHODS Patients with no histories of liver disease (n = 201) were studied in retrospect, grouped by bilirubin levels as no jaundice (NJ ≤ 2 mg/dL; n = 75), mild OJ (>2 mg/dL and ≤ 4 mg/dL; n = 56), and severe OJ (> 4 mg/dL; n = 70). For comparison, another 75 patients with chronic hepatitis B and C infections and histologically proven liver fibrosis were similarly analyzed. Each patient underwent spin-echo echo-planar-imaging MRE at 60 Hz with 3D wave postprocessing. Logistic regression and ordinary regression models were used to compare the 3D-MRE model with liver shear stiffness. RESULTS Liver shear stiffness, loss modulus, and damping ratio were incorporated into a 3D-MRE model, which significantly outperformed shear stiffness in predicting OJ severity (accuracy: 0.801 vs 0.672; p < 0.001). Both the 3D-MRE model and liver shear stiffness performed equally well in predicting the outcome of biliary drainage procedure (C-statistics: 0.852 vs 0.847; p = 0.48). The 3D-MRE model also demonstrated significantly better C-statistics than that of liver shear stiffness in discriminating mild OJ from F1-F2 liver fibrosis (0.765 vs 0.641; p = 0.005) and severe OJ from F3-F4 liver fibrosis (0.750 vs 0.635; p = 0.031). CONCLUSIONS 3D-MRE is an innovative imaging method for gauging OJ severity, predicting the outcome of biliary drainage procedure, and discriminating OJ from liver fibrosis. KEY POINTS • 3D-MR elastography achieved promising results for predicting the severity of obstructive jaundice. • Advanced parameters of 3D-MR elastography demonstrated significantly better performance than that of shear stiffness of 2D-MR elastography in discriminating obstructive jaundice from liver fibrosis caused by chronic hepatitis B/C. • Both 3D-MR elastography and 2D-MR elastography were equivalent in predicting the outcome of biliary drainage procedure.
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19
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Danielsen KV, Hove JD, Nabilou P, Yin M, Chen J, Zhao M, Kallemose T, Teisner AS, Siebner HR, Ehman RL, Møller S, Bendtsen F. Using MR elastography to assess portal hypertension and response to beta-blockers in patients with cirrhosis. Liver Int 2021; 41:2149-2158. [PMID: 34060714 PMCID: PMC8373798 DOI: 10.1111/liv.14981] [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: 02/22/2021] [Revised: 05/18/2021] [Accepted: 05/27/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND MR elastography can determine organ-related stiffness, which reflects the degree of fibrosis. Liver stiffness increases in cirrhosis, and stiffness increases further post-prandially due to increased portal blood in-flow. Non-selective beta-blockers (NSBB) reduce the portal venous inflow, but their effect on liver and spleen stiffness are disputed. AIMS To assess whether MR elastography of the liver or spleen reflects the severity of cirrhosis, whether treatment with NSBB changes liver and spleen stiffness and whether changes in stiffness can predict the effect of NSBB on portal pressure. METHODS Fifty-two patients with cirrhosis underwent liver vein catheterization and two-dimensional (2D) MR elastography on separate days. Thirty-six of the patients had a hepatic venous pressure gradient (HVPG) of ≥12 mmHg and were tested prior to, and after, intravenous infusion of NSBB using HVPG measurement and MR elastography. RESULTS HVPG showed a strong, positive, linear relationship with liver stiffness (r2 = 0.92; P < .001) and spleen stiffness (r2 = 0.94; P < .001). The cut-off points for identifying patients with a HVPG ≥ 12 mmHg were 7.7 kPa for liver stiffness (sensitivity 0.78, specificity 0.64) and 10.5 kPa for spleen stiffness (sensitivity 0.8, specificity 0.79). Intravenous administration of NSBB significantly decreased spleen stiffness by 6.9% (CI: 3.5-10.4, P < .001), but NSBB had no consistent effect on liver stiffness. However, changes in spleen stiffness were not related to the HVPG response (P = .75). CONCLUSIONS Two-dimensional MR elastographic estimation of liver or spleen stiffness reflects the degree of portal hypertension in patients with liver cirrhosis, but changes in stiffness after NSBB do not predict the effect on HVPG.
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Affiliation(s)
- Karen Vagner Danielsen
- Centre of Gastroenterology, Medical division, Copenhagen University Hospital Hvidovre, Denmark,Dept. Clinical Physiology and Nuclear Medicine, Centre of Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Jens Dahlgaard Hove
- Dept. of Cardiology, Copenhagen University Hospital Hvidovre, Denmark,Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen
| | - Puria Nabilou
- Centre of Gastroenterology, Medical division, Copenhagen University Hospital Hvidovre, Denmark
| | - Meng Yin
- Dept. of Radiology, Mayo Clinic, Rochester, cx USA
| | - Jun Chen
- Dept. of Radiology, Mayo Clinic, Rochester, cx USA
| | - Mirabella Zhao
- Centre of Gastroenterology, Medical division, Copenhagen University Hospital Hvidovre, Denmark
| | - Thomas Kallemose
- Clinical Research Department. Copenhagen University Hospital Hvidovre, Denmark
| | - Ane Søgaard Teisner
- Centre of Gastroenterology, Medical division, Copenhagen University Hospital Herlev, Denmark
| | - Hartwig Roman Siebner
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen,Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | | | - Søren Møller
- Dept. Clinical Physiology and Nuclear Medicine, Centre of Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark,Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen
| | - Flemming Bendtsen
- Centre of Gastroenterology, Medical division, Copenhagen University Hospital Hvidovre, Denmark,Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen
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20
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Reeder SB. Emergence of 3D MR Elastography-based Quantitative Markers for Diffuse Liver Disease. Radiology 2021; 301:163-165. [PMID: 34374596 DOI: 10.1148/radiol.2021211444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Scott B Reeder
- From the Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin, 1111 Highland Ave, Madison, WI 53705
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21
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Andoh F, Yue JL, Julea F, Tardieu M, Noûs C, Pagé G, Garteiser P, Van Beers BE, Maitre X, Pellot-Barakat C. Multifrequency magnetic resonance elastography for elasticity quantitation and optimal tissue discrimination: A two-platform liver fibrosis mimicking phantom study. NMR IN BIOMEDICINE 2021; 34:e4543. [PMID: 34037285 DOI: 10.1002/nbm.4543] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 06/12/2023]
Abstract
In the framework of algebraic inversion, magnetic resonance elastography (MRE) repeatability, reproducibility and robustness were evaluated on extracted shear velocities (or elastic moduli). The same excitation system was implemented at two sites equipped with clinical MR scanners of 1.5 and 3 T. A set of four elastic, isotropic, homogeneous calibrated phantoms of distinct elasticity representing the spectrum of liver fibrosis severity was mechanically characterized. The repeatability of the measurements and the reproducibility between the two platforms were found to be excellent with mean coefficients of variations of 1.62% for the shear velocity mean values and 1.95% for the associated standard deviations. MRE velocities were robust to the amplitude and pattern variations of the displacement field with virtually no difference between outcomes from both magnets at identical excitation frequencies, even when the displacement field amplitude was six times smaller. However, MRE outcomes were very sensitive to the number of voxels per wavelength, s, of the recorded displacement field, with relative biases reaching 62% and precision loss by a factor of up to 23.5. For both magnetic field strengths, MRE accuracy and precision were largely degraded outside of established conditions of validity (6 ≲ s ≲ 9), resulting in estimated shear velocity values not significantly different between phantoms of increasing elasticity. When fulfilling the spatial sampling conditions, either prospectively in the acquisition or retrospectively before the reconstruction, MRE produced quantitative measurements that allowed to unambiguously discriminate, with infinitesimal p values, between the phantoms mimicking increasing severity of liver fibrosis.
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Affiliation(s)
- Fatiha Andoh
- CEA, CNRS, Inserm, BioMaps, Université Paris-Saclay, Orsay, France
| | - Jin Long Yue
- CEA, CNRS, Inserm, BioMaps, Université Paris-Saclay, Orsay, France
| | - Felicia Julea
- Laboratory of Imaging Biomarkers, Center for Research on Inflammation, UMR 1149, Inserm, Université de Paris, Paris, France
| | - Marion Tardieu
- Montpellier Cancer Research Institute (IRCM), Inserm, University of Montpellier, Montpellier, France
| | | | - Gwenaël Pagé
- Laboratory of Imaging Biomarkers, Center for Research on Inflammation, UMR 1149, Inserm, Université de Paris, Paris, France
| | - Philippe Garteiser
- Laboratory of Imaging Biomarkers, Center for Research on Inflammation, UMR 1149, Inserm, Université de Paris, Paris, France
| | - Bernard E Van Beers
- Laboratory of Imaging Biomarkers, Center for Research on Inflammation, UMR 1149, Inserm, Université de Paris, Paris, France
- Department of Radiology, Beaujon University Hospital Paris Nord AP-HP, Clichy, France
| | - Xavier Maitre
- CEA, CNRS, Inserm, BioMaps, Université Paris-Saclay, Orsay, France
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Comparison of diffusion-weighted imaging and MR elastography in staging liver fibrosis: a meta-analysis. Abdom Radiol (NY) 2021; 46:3889-3907. [PMID: 33770223 DOI: 10.1007/s00261-021-03055-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/02/2021] [Accepted: 03/09/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare the diagnostic performance of diffusion-weighted imaging (DWI), gradient-recalled echo-based magnetic resonance elastography (GRE-MRE), and spin-echo echo-planar imaging-based MRE (SE-EPI-MRE) in liver fibrosis staging. METHODS A systematic literature search was done to collect studies on the performance of DWI, GRE-MRE, and SE-EPI-MRE for diagnosing liver fibrosis. Pooled sensitivity, specificity, diagnostic odds ratio, positive and negative likelihood ratio, and a summary receiver operating characteristic (ROC) curve were estimated with a bivariate random effects model. Subgroup analyses on various study characteristics were performed. RESULTS Sixty studies with a total of 6620 patients were included in the meta-analysis. Pooled sensitivity and specificity of GRE-MRE and SE-EPI-MRE showed high diagnostic accuracy and did not differ significantly. The area under the summary ROC curve for all stages of fibrosis differed significantly between DWI (0.83-0.88) and either GRE-MRE (0.95-0.97) or SE-EPI-MRE (0.95-0.99). Substantial heterogeneity was detected for all three imaging methods. CONCLUSIONS Both GRE-MRE and SE-EPI-MRE are highly accurate for detection of each liver fibrosis stage, with high potential to replace liver biopsy. Although DWI had a moderate accuracy in distinguishing liver fibrosis, it could be regarded as an alternative to MRE, since it is widely available and easily implemented in routine liver MRI.
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Comparison of the diagnostic performance of 2D and 3D MR elastography in staging liver fibrosis. Eur Radiol 2021; 31:9468-9478. [PMID: 34023968 DOI: 10.1007/s00330-021-08053-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/16/2021] [Accepted: 05/06/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To compare the diagnostic performance and image quality of state-of-the-art 2D MR elastography (MRE) and 3D MRE in the basic application of liver fibrosis staging. METHODS This retrospective study assessed data from 293 patients who underwent 2D and 3D MRE examinations. MRE image quality was assessed with a qualitative 2-point grading system by evaluating artifacts. Two experienced analysts independently measured mean liver stiffness values. The interobserver agreement of liver stiffness measurement was assessed by the intraclass correlation coefficient (ICC). The area under the receiver operating characteristic curve (AUC) was used to assess the diagnostic performance of 2D and 3D MRE and blood-based markers for fibrosis staging using the pathology-proven liver fibrosis stage as the gold standard. RESULTS The image quality provided by 3D MRE was graded as significantly higher than that obtained with the 2D MRE method (p < 0.01). Interobserver agreement in liver stiffness measurements was higher for 3D MRE (ICC: 3D 0.979 vs 2D 0.955). The AUC values for discriminating ≥ F1, ≥ F2, ≥ F3, and F4 fibrosis for 3D MRE (0.89, 0.92, 0.95, and 0.93) were similar to those for 2D MRE (0.89, 0.91, 0.94, and 0.92). Both the 2D and 3D MRE methods provided superior accuracy to the blood-based biomarkers, including APRI, FIB-4, and Forns index, especially for ≥ F2, ≥ F3, and F4 fibrosis stages (all p < 0.01). CONCLUSIONS While 3D MRE offers certain advantages and opportunities for new applications of MRE, current widely deployed 2D MRE technology has comparable performance in the basic application of detecting and staging liver fibrosis. KEY POINTS • 2D MRE and 3D MRE have comparable diagnostic performance in detecting and staging liver fibrosis. • 3D MRE has superior image quality and interobserver agreement compared to 2D MRE.
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Zhou X, Rao J, Wu X, Deng R, Ma Y. Comparison of 2-D Shear Wave Elastography and Point Shear Wave Elastography for Assessing Liver Fibrosis. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:408-427. [PMID: 33342618 DOI: 10.1016/j.ultrasmedbio.2020.11.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/08/2020] [Accepted: 11/16/2020] [Indexed: 06/12/2023]
Abstract
Progressive liver fibrosis may result in cirrhosis, portal hypertension and increased risk of hepatocellular carcinoma. We performed a meta-analysis to compare liver fibrosis staging in chronic liver disease patients using 2-D shear wave elastography (2-D SWE) and point shear wave elastography (pSWE). The PubMed, Web of Science and Cochrane Library databases were searched until May 31, 2020 for studies evaluating the diagnostic performance of 2-D SWE and pSWE in assessing liver fibrosis. Pooled sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratios and area under receiver operating characteristic curve were estimated using the bivariate random effects model. As a result, 71 studies with 11,345 patients were included in the analysis. The pooled sensitivities of 2-D SWE and pSWE significantly differed for the detection of significant fibrosis (F ≥ 2; 0.84 vs. 0.76, p < 0.001) and advanced fibrosis (F ≥ 3; 0.90 vs. 0.83, p = 0.003), but not for detection of cirrhosis (F = 4; 0.89 vs. 0.85, p = 0.090). The pooled specificities of 2-D SWE and pSWE did not significantly differ for detection of F ≥ 2 (0.81 vs. 0.79, p = 0.753), F ≥ 3 (0.87 vs. 0.83, p = 0.163) or F = 4 (0.87 vs. 0.84, p = 0.294). Both 2-D SWE and pSWE have high sensitivity and specificity for detecting each stage of liver fibrosis. Two-dimensional SWE has higher sensitivity than pSWE for detection of significant fibrosis and advanced fibrosis.
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Affiliation(s)
- Xiaozhuan Zhou
- Organ Transplant Center, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jiawei Rao
- Organ Transplant Center, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xukun Wu
- Organ Transplant Center, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ronghai Deng
- Organ Transplant Center, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yi Ma
- Organ Transplant Center, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
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Zou LQ, Zhao F, Zhang H, Zhang K, Xing W. Staging liver fibrosis on multiparametric MRI in a rabbit model with elastography, susceptibility-weighted imaging and T1ρ imaging: a preliminary study. Acta Radiol 2021; 62:155-163. [PMID: 32326722 DOI: 10.1177/0284185120917117] [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] [Indexed: 12/13/2022]
Abstract
BACKGROUND Magnetic resonance elastography (MRE), susceptibility-weighted imaging (SWI), and T1ρ are three techniques for staging of liver fibrosis (LF). PURPOSE To assess the value of MRE, SWI, and T1ρ imaging in staging LF. MATERIAL AND METHODS Sixty rabbits were injected with 50% CCl4oil solution, whereas 20 rabbits were given normal saline. All rabbits underwent pathological examination to determine LF stages. The liver stiffness (LS), liver-to-muscle signal intensity ratio (SIR), and T1ρ values were measured from MRE, SWI, and T1ρ imaging, respectively. RESULTS The number of rabbits was 14, 11, 10, 9, and 11 for F0, F1, F2, F3, and F4, respectively. LS (r = 0.91) and T1ρ (r = 0.51) positively correlated with LF stages, while negative correlation was present for SIR (r = -0.81). Among the three parameters, the LS values revealed the best diagnostic efficacy in staging LF, with an AUC value of 0.95 for ≥F1, 0.95 for ≥F2, 0.99 for ≥F3, and 0.98 for ≥F4. The combination of LS and SIR could best predict LF stages ≥F1, ≥F2, ≥F3 and ≥F4, with AUC values of 0.97, 0.98, 0.99, and 0.99, respectively, which were greater than those of the other two-paired parameters. A multiparametric analysis showed that the combination of all three parameters had AUC values of 0.97, 0.98, 1.00, and 1.00 for staging ≥F1, ≥F2, ≥F3, and ≥F4, respectively. CONCLUSION Multiparametric MR imaging was superior to individual imaging for LF staging.
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Affiliation(s)
- Li-Qiu Zou
- Department of Radiology, The Sixth Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, PR China
| | - Feng Zhao
- Department of Radiation Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR China
| | - Hao Zhang
- Department of Radiology, Affiliated Shenzhen Sixth Hospital of Guangdong Medical University, Shenzhen, PR China
| | - Kai Zhang
- Department of Radiology, Affiliated Shenzhen Sixth Hospital of Guangdong Medical University, Shenzhen, PR China
| | - Wei Xing
- Department of Radiology, Third Affiliated Hospital of Soochow University & Changzhou First People’s Hospital, Changzhou, Jiangsu, PR China
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Wang X, Hu Y, Lu X, Cai Y, Shu J. Quantitative T2 mapping of rats with chronic hepatitis. Exp Ther Med 2021; 21:225. [PMID: 33603834 PMCID: PMC7851601 DOI: 10.3892/etm.2021.9656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 12/04/2020] [Indexed: 11/29/2022] Open
Abstract
The aim of the study was to explore the diagnostic value of T2 mapping in an experimental rat model of chronic liver disease. Chronic hepatitis was induced in Sprague-Dawley male rats (n=88) by intraperitoneal and abdominal subcutaneous injection of carbon tetrachloride in olive oil. The normal control rats (n=12) were similarly injected with the same dose of normal saline. All rats were randomly selected and subjected to T2-weighted/spectral adiabatic inversion recovery and multiple gradient- and spin-echo sequence. After scanning, rats were sacrificed immediately and livers removed for staining with hematoxylin and eosin, as well as Masson's trichrome, to determine the pathological stage of hepatic fibrosis, necroinflammatory activity and steatosis. The T2 values were measured and associated with histopathological findings. The T2 values were significantly associated with hepatic fibrosis (P<0.05), but not with hepatitis (P>0.05) or steatosis (P>0.05). By partial correlation analysis, a significant positive correlation was observed between the T2 values and stages of liver fibrosis (r=0.820; P<0.05). T2 values increased with progressive hepatic fibrosis. The differences between T2 values and stages of liver fibrosis were statistically significant. Statistically significant differences were observed between different stages of liver fibrosis (P<0.05), with an area under the curve value of 0.944 for predicting stage F1 or greater, 0.942 for stage F2 or greater, 0.958 for stage F3 or greater, and 0.948 for F4. Thus, the T2 value is one of the quantitative indices of imaging and accurately reflects the stages of liver fibrosis.
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Affiliation(s)
- Xiaofeng Wang
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Yan Hu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Xin Lu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Yu Cai
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Jian Shu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
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MR Elastography. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00058-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Wei H, Song B. Elastography for Longitudinal Assessment of Liver Fibrosis after Antiviral Therapy: A Review. J Clin Transl Hepatol 2020; 8:445-453. [PMID: 33447528 PMCID: PMC7782123 DOI: 10.14218/jcth.2020.00033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/23/2020] [Accepted: 08/10/2020] [Indexed: 02/05/2023] Open
Abstract
Chronic hepatitis B or C viral infection is a common cause of liver cirrhosis and hepatocellular carcinoma. Fibrosis regression can be achieved after long-term antiviral therapy (AVT). Monitoring of dynamic changes in liver fibrosis after treatment is essential for establishing prognosis and formulation of a follow-up surveillance program. Routine surveillance of fibrosis after AVT by liver biopsy, the gold standard for fibrosis assessment, is hindered by its invasive nature, sampling error and observer variability. Elastography is a noninvasive quantitative alternative that has been widely used and validated for the staging of liver fibrosis prior to treatment. Recently, increasing research interest has been focused on the role of elastography in longitudinal assessment of liver fibrosis after AVT. In this review, the basic principles, acquisition techniques, diagnostic performances, and strengths and limitations of ultrasound elastography and magnetic resonance elastography are presented. Emerging evidence regarding the use of elastography techniques for the monitoring of liver fibrosis after AVT is summarized. Current challenges and future directions are also discussed, designed to optimize the application of these techniques in clinical practice.
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Affiliation(s)
- Hong Wei
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Bin Song
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Correspondence to: Bin Song, Department of Radiology, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan 610041, China. Tel: +86-28-85423680, Fax: +86-28-85582499, E-mail:
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Plaikner M, Kremser C, Viveiros A, Zoller H, Henninger B. [Magnetic resonance elastography of the liver : Worth knowing for clinical routine]. Radiologe 2020; 60:966-978. [PMID: 32399783 DOI: 10.1007/s00117-020-00690-6] [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] [Indexed: 11/27/2022]
Abstract
BACKGROUND Magnetic resonance elastography (MRE) is a noninvasive, quantitative, MRI-based method to evaluate liver stiffness. Beside biopsy and ultrasound elastography, this imaging method plays in many places a significant role in the detection and additive characterization of chronic liver disease. OBJECTIVES, MATERIALS AND METHODS Based on the literature, a brief review of the underlying method and the commercially available products is given. Furthermore, the practical procedure, the analysis, and the interpretation of clinically relevant questions are illustrated and a comparison with ultrasound elastography is provided. RESULTS This relative "young" MRI method allows extensive evaluation of mechanical properties of the liver and is an important diagnostic tool especially in follow-up examinations. The MRE of the liver is with a maximum technical failure rate of 5.8% a robust technique with high accuracy and an excellent re-test reliability as well as intra- and interobserver reproducibility. There is a high diagnostic certainty within the framework of most important clinical indications, the quantification of fibrosis, and with a very good correlation with the "gold standard" biopsy. CONCLUSION Based on its rising clinical relevance and the broad usage, MRE of the liver is increasingly used in many centers and in routine liver protocols. Therefore, basic knowledge of this method is essential for every radiologist.
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Affiliation(s)
- Michaela Plaikner
- Radiologie, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.
| | - Christian Kremser
- Radiologie, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - André Viveiros
- Innere Medizin I, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Heinz Zoller
- Innere Medizin I, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Benjamin Henninger
- Radiologie, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
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30
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Lai LY, Huang MP, Su S, Shu J. Liver Fibrosis Staging with Gadolinium Ethoxybenzyl Diethylenetriamine Penta-Acetic Acid-enhanced: A Systematic Review and Meta-analysis. Curr Med Imaging 2020; 17:854-863. [PMID: 33256584 DOI: 10.2174/1573405616666201130101229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/25/2020] [Accepted: 08/09/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE While liver biopsy is the golden standard for liver-fibrosis diagnosis, it is also invasive and has many limitations. Non-invasive techniques such as Magnetic Resonance Imaging (MRI) need to be further developed for liver fibrosis staging. This study aimed to evaluate the diagnostic accuracy of Gadolinium Ethoxybenzyl Diethylenetriamine Penta-acetic Acid (Gd-EOBDTPA)- enhanced MRI for liver fibrosis through systematic review and meta-analysis. METHODS This study comprehensively searched relevant article in PubMed, Embase, and the Cochrane Library published from 2004 to 2018 to find studies analyzing the diagnostic accuracy of Gd-EOB-DTPA-enhanced MRI for liver fibrosis. Two reviewers independently screened the retrieved articles, extracted the required data from the included studies, and evaluated the methodological quality of the studies. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and Summary Receiver Operating Characteristics (SROC) curve were assessed. RESULTS This study finally included 16 studies (n = 1,599) and selected a random-effects model based on the results of the I2 statistic to combine them. The areas under the SROC curve for the detection of F1 or greater, F2 or greater, F3 or greater, or F4 liver fibrosis were 0.8669, 0.8399, 0.8481, and 0.8858, respectively. CONCLUSION Gd-EOB-DTPA-enhanced MRI showed a good diagnostic performance for staging liver fibrosis, especially for F4 liver fibrosis.
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Affiliation(s)
- Lu-Yao Lai
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Meng-Ping Huang
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Song Su
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Jian Shu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
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MR elastography of liver: current status and future perspectives. Abdom Radiol (NY) 2020; 45:3444-3462. [PMID: 32705312 DOI: 10.1007/s00261-020-02656-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/06/2020] [Accepted: 07/09/2020] [Indexed: 02/08/2023]
Abstract
Non-invasive evaluation of liver fibrosis has evolved over the last couple of decades. Currently, elastography techniques are the most widely used non-invasive methods for clinical evaluation of chronic liver disease (CLD). MR elastography (MRE) of the liver has been used in the clinical practice for nearly a decade and continues to be widely accepted for detection and staging of liver fibrosis. With MRE, one can directly visualize propagating shear waves through the liver and an inversion algorithm in the scanner automatically converts the shear wave properties into an elastogram (stiffness map) on which liver stiffness can be calculated. The commonly used MRE method, two-dimensional gradient recalled echo (2D-GRE) sequence has produced excellent results in the evaluation of liver fibrosis in CLD from various etiologies and newer clinical indications continue to emerge. Advances in MRE technique, including 3D MRE, automated liver elasticity calculation, improvements in shear wave delivery and patient experience, are promising to provide a faster and more reliable MRE of liver. Innovations, including evaluation of mechanical parameters, such as loss modulus, displacement, and volumetric strain, are promising for comprehensive evaluation of CLD as well as understanding pathophysiology, and in differentiating various etiologies of CLD. In this review, the current status of the MRE of liver in CLD are outlined and followed by a brief description of advanced techniques and innovations in MRE of liver.
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32
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Wang H, Pednekar A, Tkach JA, Bridgewater KR, Trout AT, Dillman JR, Dumoulin CL. Fusing acceleration and saturation techniques with wave amplitude labeling of time-shifted zeniths MR elastography. Magn Reson Med 2020; 85:1552-1560. [PMID: 32936497 DOI: 10.1002/mrm.28488] [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: 06/02/2020] [Revised: 07/21/2020] [Accepted: 08/03/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE To design a new 2D gradient recalled echo MR elastography (MRE) pulse sequence with inflow saturation for measuring liver stiffness in half the breath-hold time compared to standard of care (SC) 2D GRE MRE sequences. METHODS FASTWALTZ (fusing acceleration and saturation techniques with wave amplitude labeling of time-shifted zeniths) MRE employs an interleaved dual TR strategy with wave amplitude labeling and compressed SENSE undersampling to reduce breath-hold time while incorporating inflow saturation to suppress flow artifacts. The sequence was implemented and compared with SC MRE both in phantoms and in vivo in 5 asymptomatic volunteers. Stiffness values, region of interest size, and breath-hold times were compared between sequences. RESULTS Stiffness values were comparable between FASTWALTZ and SC MRE for both phantoms and in-vivo data. In volunteers, the group mean stiffness values at 60 Hz and region of interest size were 1.96 ± 0.30 kilopascals and 2279 ± 516 mm2 for SC MRE, and 1.95 ± 0.29 kilopascals and 2061 ± 464 mm2 for FASTWALTZ. Breath-hold duration for FASTWALTZ was 6.3 s compared to 13.3 s for SC MRE. CONCLUSION FASTWALTZ provides comparable stiffness values in half the breath-hold time compared to SC MRE and may have clinical benefits in patients with limited breath-holding capacity.
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Affiliation(s)
- Hui Wang
- MR Clinical Science, Philips, Cincinnati, Ohio, USA.,Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Amol Pednekar
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kaley R Bridgewater
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Charles L Dumoulin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Thromboembolic Events Are Independently Associated with Liver Stiffness in Patients with Fontan Circulation. J Clin Med 2020; 9:jcm9020418. [PMID: 32032996 PMCID: PMC7073638 DOI: 10.3390/jcm9020418] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 01/26/2020] [Accepted: 01/31/2020] [Indexed: 01/20/2023] Open
Abstract
Background: Thromboembolism (TE) and Fontan-associated liver disease (FALD) are common and lead to significant morbidity in Fontan circulations. Risk factors for TE and the potential link between TE and FALD are not well understood. The objective of this study was to evaluate the association between TE and the severity of FALD based on radiologic liver stiffness. Methods: Using a retrospective cohort study design, 85 Fontan patients (aged 27.7 ± 8.2 years) who had liver stiffness measurement were included. Multivariable logistic regression was used to determine independent associations with TE. Results: Sixteen patients (19%) had a history of TE after the Fontan procedure at a mean age of 21.4 ± 15.0 years. Patients with TE were significantly older at the time of the last evaluation (33.8 ± 11.7 vs. 26.3 ± 6.5 years, p = 0.03). Liver stiffness by MRI and ultrasound was higher in the TE group (5.1 ± 1.4 vs. 4.3 ± 1.2 kPa, p = 0.04 and 2.8 ± 0.4 vs. 2.4 ± 0.5 m/s, p = 0.04, respectively). On multivariable analysis, higher liver stiffness (odds ratio (OR): 2.12, p = 0.03) and older age (OR: 1.11, p = 0.03) were associated with TE. Conclusions: This study found an association between TE, age, and radiologic liver stiffness.
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Yang D, Li D, Li J, Yang Z, Wang Z. Systematic review: The diagnostic efficacy of gadoxetic acid-enhanced MRI for liver fibrosis staging. Eur J Radiol 2020; 125:108857. [PMID: 32113153 DOI: 10.1016/j.ejrad.2020.108857] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 12/07/2019] [Accepted: 01/27/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate the diagnostic efficacy of gadoxetic acid-enhanced MRI for the staging of liver fibrosis by meta-analysis. METHODS PubMed/Medline, EMBASE, the Web of Science, and the Cochrane Library were searched. Studies were included according to their eligibility and the exclusion criteria. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to assess the methodologic quality. The bivariate random-effects model was used to obtain the pooled summary estimates, heterogeneity, and the area under summary receiver operating characteristic curves (AUROC). Meta-regression was performed to discover the source of heterogeneity and compare certain some subsets for their capacity to stage hepatic fibrosis by AUROC comparison. RESULTS A total of 20 original articles (1936 patients) were included. Most studies had a low risk of bias and minimal concerns regarding applicability. The summary AUROC values of gadoxetic acid-enhanced MRI in staging the liver fibrosis ≥ F1, ≥ F2, ≥ F3, and F4 subsets were 0.92, 0.87, 0.89, and 0.91, respectively. Studies with populations equal to or more than 100 had a significantly higher sensitivity (84 %) and specificity (91 %) than those with populations less than 100 (70 % and 77 %, respectively, P < 0.01). Studies of a prospective design exhibited a significantly higher sensitivity (94 %) and specificity (94 %) than those of a retrospective design (75 % and 84 %, respectively, P < 0.01). CONCLUSIONS Our meta-analysis shows the high diagnostic efficacy of gadoxetic acid-enhanced MRI in the staging of liver fibrosis. A prospective study with more than one hundred patients showed higher diagnostic efficacy.
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Affiliation(s)
- Dawei Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China; Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, Beijing 100050, China.
| | - Dan Li
- Department of Radiology, Beijing Changping Hospital, Beijing 102200, China.
| | - Jinshui Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
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Kim HJ, Kim B, Yu HJ, Huh J, Lee JH, Lee SS, Kim KW, Kim JK. Reproducibility of hepatic MR elastography across field strengths, pulse sequences, scan intervals, and readers. Abdom Radiol (NY) 2020; 45:107-115. [PMID: 31720766 DOI: 10.1007/s00261-019-02312-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the reproducibility of hepatic MRE under various combinations of settings of field strength, pulse sequence, scan interval, and reader in non-alcoholic fatty liver disease (NAFLD) patients. METHODS Adult NAFLD patients were prospectively enrolled for serial hepatic MRE with 1.5 T using 2D GRE sequence and 3.0 T using 2D SE-EPI sequence on the same day and after 2 weeks, resulting a total of four MRE examinations per patient. Three readers with various levels of background knowledge in MRE technique and liver anatomy measured liver stiffness after a training session. Linear regression, Bland-Altman analysis, within-subject coefficient of variation, and reproducibility coefficient (RDC) were used to determine reproducibility of hepatic MRE measurement. RESULTS Twenty patients completed the MRE sessions. Liver stiffness through MRE showed pooled RDC of 26% (upper 95% CI 30.6%) and corresponding limits of agreement (LOA) within 0.55 kPa across field strengths, MRE sequences, and 2-week interscan interval in three readers. Small mean biases and narrow LOA were observed among readers (0.05-0.19 kPa ± 0.53). CONCLUSION The magnitude of change across combinations of scan parameters is within acceptable clinical range, rendering liver stiffness through MRE a reproducible quantitative imaging biomarker. A lower reproducibility was observed for measurements under different field strengths/MRE sequences at a longer (2 weeks) interscan interval. Operators should be trained to acquire region of interest consistently in repeat examinations.
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Affiliation(s)
- Hye Jin Kim
- Department of Radiology, Ajou University School of Medicine, Ajou University Hospital, 164 World cup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Bohyun Kim
- Department of Radiology, Ajou University School of Medicine, Ajou University Hospital, 164 World cup-ro, Yeongtong-gu, Suwon, 16499, South Korea.
| | - Hyun Jeong Yu
- Department of Radiology, Ajou University School of Medicine, Ajou University Hospital, 164 World cup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Jimi Huh
- Department of Radiology, Ajou University School of Medicine, Ajou University Hospital, 164 World cup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Jei Hee Lee
- Department of Radiology, Ajou University School of Medicine, Ajou University Hospital, 164 World cup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jai Keun Kim
- Department of Radiology, Ajou University School of Medicine, Ajou University Hospital, 164 World cup-ro, Yeongtong-gu, Suwon, 16499, South Korea
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Bunevicius A, Schregel K, Sinkus R, Golby A, Patz S. REVIEW: MR elastography of brain tumors. NEUROIMAGE-CLINICAL 2019; 25:102109. [PMID: 31809993 PMCID: PMC6909210 DOI: 10.1016/j.nicl.2019.102109] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/19/2019] [Accepted: 11/22/2019] [Indexed: 12/28/2022]
Abstract
MR elastography allows non-invasive quantification of the shear modulus of tissue. MRE correlates with intra-operative consistency of meningiomas, pituitary adenomas. Reported shear modulus values are widely distributed and overlap. Meningiomas were the stiffest tumor-type relative to normal appearing white matter. Studies are needed to determine clinical applications of MRE in neuro-oncology.
MR elastography allows non-invasive quantification of the shear modulus of tissue, i.e. tissue stiffness and viscosity, information that offers the potential to guide presurgical planning for brain tumor resection. Here, we review brain tumor MRE studies with particular attention to clinical applications. Studies that investigated MRE in patients with intracranial tumors, both malignant and benign as well as primary and metastatic, were queried from the Pubmed/Medline database in August 2018. Reported tumor and normal appearing white matter stiffness values were extracted and compared as a function of tumor histopathological diagnosis and MRE vibration frequencies. Because different studies used different elastography hardware, pulse sequences, reconstruction inversion algorithms, and different symmetry assumptions about the mechanical properties of tissue, effort was directed to ensure that similar quantities were used when making inter-study comparisons. In addition, because different methodologies and processing pipelines will necessarily bias the results, when pooling data from different studies, whenever possible, tumor values were compared with the same subject's contralateral normal appearing white matter to minimize any study-dependent bias. The literature search yielded 10 studies with a total of 184 primary and metastatic brain tumor patients. The group mean tumor stiffness, as measured with MRE, correlated with intra-operatively assessed stiffness of meningiomas and pituitary adenomas. Pooled data analysis showed significant overlap between shear modulus values across brain tumor types. When adjusting for the same patient normal appearing white matter shear modulus values, meningiomas were the stiffest tumor-type. MRE is increasingly being examined for potential in brain tumor imaging and might have value for surgical planning. However, significant overlap of shear modulus values between a number of different tumor types limits applicability of MRE for diagnostic purposes. Thus, further rigorous studies are needed to determine specific clinical applications of MRE for surgical planning, disease monitoring and molecular stratification of brain tumors.
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Affiliation(s)
- Adomas Bunevicius
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, United States; Harvard Medical School, Boston, MA, United States.
| | - Katharina Schregel
- Institute of Neuroradiology, University Medical Center Goettingen, Goettingen, Germany
| | - Ralph Sinkus
- Inserm U1148, LVTS, University Paris Diderot, University Paris 13, Paris, France
| | - Alexandra Golby
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, United States; Harvard Medical School, Boston, MA, United States; Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, United States
| | - Samuel Patz
- Harvard Medical School, Boston, MA, United States; Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, United States.
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Technical success rates and reliability of spin-echo echo-planar imaging (SE-EPI) MR elastography in patients with chronic liver disease or liver cirrhosis. Eur Radiol 2019; 30:1730-1737. [PMID: 31728687 DOI: 10.1007/s00330-019-06496-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/01/2019] [Accepted: 10/02/2019] [Indexed: 01/20/2023]
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Alsaied T, Possner M, Lubert AM, Trout AT, Szugye C, Palermo JJ, Lorts A, Goldstein BH, Veldtman GR, Anwar N, Dillman JR. Relation of Magnetic Resonance Elastography to Fontan Failure and Portal Hypertension. Am J Cardiol 2019; 124:1454-1459. [PMID: 31474329 DOI: 10.1016/j.amjcard.2019.07.052] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 12/11/2022]
Abstract
Fontan associated liver disease is associated with morbidity and mortality in palliated single-ventricle congenital heart disease patients. Magnetic resonance elastography (MRE) provides a quantitative assessment of liver stiffness in Fontan patients. We hypothesized that MRE liver stiffness correlates with liver enzymes, hemodynamics, portal hypertension, and Fontan failure (FF). All adult Fontan patients who had MRE between 2011 and 2018 were included. Radiologic portal hypertension was defined as splenomegaly, ascites, and/or varices. FF was defined as death, transplantation, or heart failure symptoms requiring escalation of diuretics. Seventy patients with a median age of 24.7 years and a median follow-up from MRE of 3.9 years were included. The median liver stiffness was 4.3 kPa (interquartile range [IQR]: 3.8 to 5.0 kPa). There was a weak, positive correlation between liver stiffness and Fontan pathway pressure (r = 0.34, p = 0.03). There was a moderate negative correlation of liver stiffness with ventricular ejection fraction (r = -0.52, p = 0.03). Liver stiffness was weakly positively correlated with liver transaminases and gamma glutamyl transferase. Patients with portal hypertension had higher liver stiffness compared to patients without (5.2 ± 1.3 vs 4.2 ± 0.8 kPa, p = 0.03). At MRE or during follow-up, 13 patients (19%) met definition of FF and had significantly higher liver stiffness compared to patients without FF (5.1 [IQR: 4.3 to 6.3] vs 4.2 [IQR: 3.7 to 4.7] kPa, p = 0.01). Liver stiffness above 4.5 kPa differentiated FF with a sensitivity of 77% and specificity of 77%. In conclusion, elevated MRE-derived liver stiffness is associated with worse hemodynamics, liver enzymes and clinical outcomes in Fontan patients. This measure may serve as a global imaging biomarker of Fontan health.
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Affiliation(s)
- Tarek Alsaied
- Cincinnati Children's Hospital Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine Cincinnati, Ohio.
| | - Mathias Possner
- Cincinnati Children's Hospital Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine Cincinnati, Ohio
| | - Adam M Lubert
- Cincinnati Children's Hospital Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine Cincinnati, Ohio
| | - Andrew T Trout
- Cincinnati Children's Hospital Medical Center, Department of Radiology, University of Cincinnati College of Medicine Cincinnati, Ohio
| | - Cassandra Szugye
- Cincinnati Children's Hospital Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine Cincinnati, Ohio
| | - Joseph J Palermo
- Cincinnati Children's Hospital Medical Center, Division of Gastroenterology, Department of Pediatrics, University of Cincinnati College of Medicine Cincinnati, Ohio
| | - Angela Lorts
- Cincinnati Children's Hospital Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine Cincinnati, Ohio
| | - Bryan H Goldstein
- Cincinnati Children's Hospital Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine Cincinnati, Ohio
| | - Gruschen R Veldtman
- Cincinnati Children's Hospital Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine Cincinnati, Ohio; Adult Congenital Heart Disease, Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Nadeem Anwar
- University of Cincinnati Medical Center, Division of Gastroenterology, Department of Medicine, University of Cincinnati College of Medicine Cincinnati, Ohio
| | - Johnathan R Dillman
- Cincinnati Children's Hospital Medical Center, Department of Radiology, University of Cincinnati College of Medicine Cincinnati, Ohio
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Kim DW, Kim SY, Yoon HM, Kim KW, Byun JH. Comparison of technical failure of MR elastography for measuring liver stiffness between gradient‐recalled echo and spin‐echo echo‐planar imaging: A systematic review and meta‐analysis. J Magn Reson Imaging 2019; 51:1086-1102. [DOI: 10.1002/jmri.26918] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/14/2019] [Indexed: 12/14/2022] Open
Affiliation(s)
- Dong Wook Kim
- The Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical Center Seoul Republic of Korea
| | - So Yeon Kim
- The Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical Center Seoul Republic of Korea
| | - Hee Mang Yoon
- The Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical Center Seoul Republic of Korea
| | - Kyung Won Kim
- The Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical Center Seoul Republic of Korea
| | - Jae Ho Byun
- The Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical Center Seoul Republic of Korea
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Abstract
OBJECTIVE. The purpose of this article is to discuss quantitative methods of CT, MRI, and ultrasound (US) for noninvasive staging of hepatic fibrosis. Hepatic fibrosis is the hallmark of chronic liver disease (CLD), and staging by random liver biopsy is invasive and prone to sampling errors and subjectivity. Several noninvasive quantitative imaging methods are under development or in clinical use. The accuracy, precision, technical aspects, advantages, and disadvantages of each method are discussed. CONCLUSION. The most promising methods are the liver surface nodularity score using CT and measurement of liver stiffness using MR elastography or US elastography.
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Guillaud O, Dumortier J, Traclet J, Restier L, Joly P, Chapuis-Cellier C, Lachaux A, Mornex JF. Assessment of liver fibrosis by transient elastography (Fibroscan ®) in patients with A1AT deficiency. Clin Res Hepatol Gastroenterol 2019; 43:77-81. [PMID: 30612958 DOI: 10.1016/j.clinre.2018.08.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/17/2018] [Accepted: 08/27/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Alpha-1-antitrypsin deficiency (A1ATD) is a common genetic condition which predisposes to emphysema and liver disorders. It is estimated that 10-15% of homozygous individuals for the Z allele (PiZZ) may develop liver fibrosis. The optimal modalities to detect liver disease in PiZZ adult patients need to be defined. The aim of this prospective study was to perform a systematic non-invasive evaluation of the liver fibrosis by elastometry using Fibroscan® in a cohort of A1ATD patients with emphysema. METHODS Patients followed in our respiratory unit were enrolled in this prospective study and underwent on the same day a physical examination, a biochemical profiling, an abdominal ultrasound (US) and a Fibroscan®. RESULTS Twenty-nine PiZZ adults (19 male) were included. Median age was 50.4 yrs (21.5-67.2). Median serum A1AT level was 0.20 g/L (0.15-0.33). Liver Function Tests (LFT) were not normal in 2 patients and US was abnormal in 6 patients. Two patients had both abdnormal LFT and US. Fibroscan® was technically feasible in 28/29 (97%) patients. Median liver stiffness was 4.5 kPa (2.8-32.8), and was > 7.2 kPa in 5/28 (18%) and > 14 kPa in 2/28 (7%) patients. Liver stiffness was increased in 2/2 (100%) patients with abnormal LFT and US, in 1/4 (25%) with abnormal LFT or US and in 2/22 (10%) patients with normal LFT and US. CONCLUSIONS Fibroscan® is an easy and repeatable tool which can be used in PiZZ patients to screen for the presence of significant liver fibrosis and to identify patients at higher risk to develop liver complications in the future and who may benefit from a closer surveillance.
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Affiliation(s)
- Olivier Guillaud
- Service d'hépato-gastro-entérologie, hôpital Édouard-Herriot, hospices civils de Lyon, 69437 Lyon, France.
| | - Jérôme Dumortier
- Service d'hépato-gastro-entérologie, hôpital Édouard-Herriot, hospices civils de Lyon, 69437 Lyon, France; Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France.
| | - Julie Traclet
- Service de pneumologie, groupement hospitalier Est, hospices civils de Lyon, 69677 Bron, France.
| | - Lioara Restier
- Service de gastro-entérologie, hépatologie et nutrition pédiatriques, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 69677 Bron, France.
| | - Philippe Joly
- Unité de pathologie moléculaire du globule rouge, laboratoire de biochimie et de biologie moléculaire, hôpital Édouard-Herriot, hospices civils de Lyon, 69437 Lyon, France.
| | - Colette Chapuis-Cellier
- Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France; Laboratoire d'immunologie, centre de biologie Sud, centre hospitalier Lyon-Sud, hospices civils, 69310 Pierre-Bénite, France.
| | - Alain Lachaux
- Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France; Service de gastro-entérologie, hépatologie et nutrition pédiatriques, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 69677 Bron, France.
| | - Jean François Mornex
- Service de pneumologie, groupement hospitalier Est, hospices civils de Lyon, 69677 Bron, France; Université de Lyon, Inra, UMR754, 69007, Lyon, France.
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Abstract
The first clinical application of magnetic resonance elastography (MRE) was in the evaluation of chronic liver disease (CLD) for detection and staging of liver fibrosis. In the past 10 years, MRE has been incorporated seamlessly into a standard magnetic resonance imaging (MRI) liver protocol worldwide. Liver MRE is a robust technique for evaluation of liver stiffness and is currently the most accurate noninvasive imaging technology for evaluation of liver fibrosis. Newer MRE sequences including spin-echo MRE and 3 dimensional MRE have helped in reducing the technical limitations of clinical liver MRE that is performed with 2D gradient recalled echo (GRE) MRE. Advances in MRE technology have led to understanding of newer mechanical parameters such as dispersion, attenuation, and viscoelasticity that may be useful in evaluating pathological processes in CLD and may prove useful in their management.This review article will describe the changes in CLD that cause an increase in stiffness followed by principle and technique of liver MRE. In the later part of the review, we will briefly discuss the advances in liver MRE.
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Kim JK, Yoon H, Lee MJ, Kim MJ, Han K, Koh H, Kim S, Han SJ, Shin HJ. Feasibility of Spin-Echo Echo-Planar Imaging MR Elastography in Livers of Children and Young Adults. ACTA ACUST UNITED AC 2019. [DOI: 10.13104/imri.2019.23.3.251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Jin Kyem Kim
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Haesung Yoon
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
- Severance Pediatric Liver Disease Research Group, Yonsei University College of Medicine, Seoul, Korea
| | - Mi-Jung Lee
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
- Severance Pediatric Liver Disease Research Group, Yonsei University College of Medicine, Seoul, Korea
| | - Myung-Joon Kim
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
- Severance Pediatric Liver Disease Research Group, Yonsei University College of Medicine, Seoul, Korea
| | - Kyunghwa Han
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hong Koh
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Yonsei University College of Medicine, Seoul, Korea
- Severance Pediatric Liver Disease Research Group, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Kim
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Yonsei University College of Medicine, Seoul, Korea
- Severance Pediatric Liver Disease Research Group, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Joo Han
- Department of Pediatric Surgery, Yonsei University College of Medicine, Seoul, Korea
- Severance Pediatric Liver Disease Research Group, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Joo Shin
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
- Severance Pediatric Liver Disease Research Group, Yonsei University College of Medicine, Seoul, Korea
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Diaz ES, Dillman JR, Veldtman GR, Trout AT. MRI measured liver stiffness does not predict focal liver lesions after the Fontan operation. Pediatr Radiol 2019; 49:99-104. [PMID: 30269160 DOI: 10.1007/s00247-018-4264-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/19/2018] [Accepted: 09/16/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Focal liver lesions are common in children and adults after Fontan procedures. OBJECTIVE To explore the relationship between liver shear stiffness, using magnetic resonance (MR) elastography, and the presence of focal liver lesions in patients after Fontan procedures (total cavopulmonary anastomosis). MATERIALS AND METHODS The retrospective study was approved by the institutional review board and the requirement for informed consent was waived. By searching institutional electronic medical records, we identified all patients with a history of Fontan palliation of congenital heart disease who had undergone same-day liver MR elastography and liver MRI without and with intravenous contrast material between January 2012 and December 2017. Using imaging reports, patients were placed into two groups: 1) no focal liver lesions and 2) one or more focal liver lesions. Patient age, sex, mean liver shear stiffness (kPa) and maximum single anatomical level liver shear stiffness (kPa) were recorded. The Mann-Whitney U test was used to compare age and liver stiffness between groups, while the Fisher exact test was used to assess the impact of gender on liver lesions. RESULTS Forty-eight patients met study inclusion criteria; 33 (69%) had one or more focal liver lesions. The median age was 20.0 years (IQR [interquartile range]: 10.8-29.1 years) for patients without liver lesions and 19.9 years (IQR: 17.2-27.0 years) for patients with liver lesions (P=0.49). Eleven of 21 male patients (52.4%) had liver lesions compared to 22 of 27 female patients (81.5%) (P=0.058). Mean (4.62 kPa [IQR: 4.10-5.59 kPa] vs. 4.10 kPa [IQR: 3.44-4.80 kPa]; P=0.02) and maximum (5.53 kPa [IQR: 4.64-6.56 kPa] vs. 4.50 kPa [IQR: 3.82-5.35 kPa]; P=0.009) liver stiffness were significantly higher in patients without liver lesions as compared to patients with liver lesions. CONCLUSION Our study demonstrated a significant negative association between focal liver lesions and increased liver stiffness in patients following Fontan procedures.
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Affiliation(s)
- Eric S Diaz
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229-3026, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229-3026, USA. .,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Gruschen R Veldtman
- Heart Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229-3026, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Yasaka K, Akai H, Kunimatsu A, Abe O, Kiryu S. Deep learning for staging liver fibrosis on CT: a pilot study. Eur Radiol 2018; 28:4578-4585. [PMID: 29761358 DOI: 10.1007/s00330-018-5499-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/10/2018] [Accepted: 04/18/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To investigate whether liver fibrosis can be staged by deep learning techniques based on CT images. METHODS This clinical retrospective study, approved by our institutional review board, included 496 CT examinations of 286 patients who underwent dynamic contrast-enhanced CT for evaluations of the liver and for whom histopathological information regarding liver fibrosis stage was available. The 396 portal phase images with age and sex data of patients (F0/F1/F2/F3/F4 = 113/36/56/66/125) were used for training a deep convolutional neural network (DCNN); the data for the other 100 (F0/F1/F2/F3/F4 = 29/9/14/16/32) were utilised for testing the trained network, with the histopathological fibrosis stage used as reference. To improve robustness, additional images for training data were generated by rotating or parallel shifting the images, or adding Gaussian noise. Supervised training was used to minimise the difference between the liver fibrosis stage and the fibrosis score obtained from deep learning based on CT images (FDLCT score) output by the model. Testing data were input into the trained DCNNs to evaluate their performance. RESULTS The FDLCT scores showed a significant correlation with liver fibrosis stage (Spearman's correlation coefficient = 0.48, p < 0.001). The areas under the receiver operating characteristic curves (with 95% confidence intervals) for diagnosing significant fibrosis (≥ F2), advanced fibrosis (≥ F3) and cirrhosis (F4) by using FDLCT scores were 0.74 (0.64-0.85), 0.76 (0.66-0.85) and 0.73 (0.62-0.84), respectively. CONCLUSIONS Liver fibrosis can be staged by using a deep learning model based on CT images, with moderate performance. KEY POINTS • Liver fibrosis can be staged by a deep learning model based on magnified CT images including the liver surface, with moderate performance. • Scores from a trained deep learning model showed moderate correlation with histopathological liver fibrosis staging. • Further improvement are necessary before utilisation in clinical settings.
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Affiliation(s)
- Koichiro Yasaka
- Department of Radiology, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Hiroyuki Akai
- Department of Radiology, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Akira Kunimatsu
- Department of Radiology, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shigeru Kiryu
- Department of Radiology, Graduate School of Medical Sciences, International University of Health and Welfare, 537-3 Iguchi, Nasushiobara, Tochigi, 329-2763, Japan.
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