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Zerunian M, Masci B, Caruso D, Pucciarelli F, Polici M, Nardacci S, De Santis D, Iannicelli E, Laghi A. Liver Magnetic Resonance Elastography: Focus on Methodology, Technique, and Feasibility. Diagnostics (Basel) 2024; 14:379. [PMID: 38396418 PMCID: PMC10887609 DOI: 10.3390/diagnostics14040379] [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: 12/28/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Magnetic resonance elastography (MRE) is an imaging technique that combines low-frequency mechanical vibrations with magnetic resonance imaging to create visual maps and quantify liver parenchyma stiffness. As in recent years, diffuse liver diseases have become highly prevalent worldwide and could lead to a chronic condition with different stages of fibrosis. There is a strong necessity for a non-invasive, highly accurate, and standardised quantitative assessment to evaluate and manage patients with different stages of fibrosis from diagnosis to follow-up, as the actual reference standard for the diagnosis and staging of liver fibrosis is biopsy, an invasive method with possible peri-procedural complications and sampling errors. MRE could quantitatively evaluate liver stiffness, as it is a rapid and repeatable method with high specificity and sensitivity. MRE is based on the propagation of mechanical shear waves through the liver tissue that are directly proportional to the organ's stiffness, expressed in kilopascals (kPa). To obtain a valid assessment of the real hepatic stiffness values, it is mandatory to obtain a high-quality examination. To understand the pearls and pitfalls of MRE, in this review, we describe our experience after one year of performing MRE from indications and patient preparation to acquisition, quality control, and image analysis.
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Affiliation(s)
- Marta Zerunian
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy; (M.Z.); (B.M.); (M.P.); (S.N.); (D.D.S.); (E.I.); (A.L.)
- PhD School in Translational Medicine and Oncology, Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Benedetta Masci
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy; (M.Z.); (B.M.); (M.P.); (S.N.); (D.D.S.); (E.I.); (A.L.)
| | - Damiano Caruso
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy; (M.Z.); (B.M.); (M.P.); (S.N.); (D.D.S.); (E.I.); (A.L.)
| | - Francesco Pucciarelli
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy; (M.Z.); (B.M.); (M.P.); (S.N.); (D.D.S.); (E.I.); (A.L.)
| | - Michela Polici
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy; (M.Z.); (B.M.); (M.P.); (S.N.); (D.D.S.); (E.I.); (A.L.)
- PhD School in Translational Medicine and Oncology, Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
| | - Stefano Nardacci
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy; (M.Z.); (B.M.); (M.P.); (S.N.); (D.D.S.); (E.I.); (A.L.)
| | - Domenico De Santis
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy; (M.Z.); (B.M.); (M.P.); (S.N.); (D.D.S.); (E.I.); (A.L.)
| | - Elsa Iannicelli
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy; (M.Z.); (B.M.); (M.P.); (S.N.); (D.D.S.); (E.I.); (A.L.)
| | - Andrea Laghi
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, Sant’Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy; (M.Z.); (B.M.); (M.P.); (S.N.); (D.D.S.); (E.I.); (A.L.)
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Gao S, Zhang Y, Sun W, Jin K, Dai Y, Wang F, Qian X, Han J, Sheng R, Zeng M. Assessment of an
MR
Elastography‐Based Nomogram as a Potential Imaging Biomarker for Predicting Microvascular Invasion of Hepatocellular Carcinoma. J Magn Reson Imaging 2022. [DOI: 10.1002/jmri.28553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Shanshan Gao
- Department of Radiology, Zhongshan Hospital Fudan University Shanghai China
- Central Research Institute United Imaging Healthcare Shanghai China
| | - Yunfei Zhang
- Central Research Institute United Imaging Healthcare Shanghai China
- Shanghai Institute of Medical Imaging Shanghai China
| | - Wei Sun
- Department of Radiology, Zhongshan Hospital Fudan University Shanghai China
- Central Research Institute United Imaging Healthcare Shanghai China
| | - Kaipu Jin
- Department of Radiology, Zhongshan Hospital Fudan University Shanghai China
- Central Research Institute United Imaging Healthcare Shanghai China
| | - Yongming Dai
- Shanghai Institute of Medical Imaging Shanghai China
| | - Feihang Wang
- Central Research Institute United Imaging Healthcare Shanghai China
- Department of Interventional Radiology, Zhongshan Hospital Fudan University Shanghai China
| | - Xianling Qian
- Department of Radiology, Zhongshan Hospital Fudan University Shanghai China
- Central Research Institute United Imaging Healthcare Shanghai China
| | - Jing Han
- Department of Pathology, Zhongshan Hospital Fudan University Shanghai China
| | - Ruofan Sheng
- Department of Radiology, Zhongshan Hospital Fudan University Shanghai China
- Department of Radiology, Zhongshan Hospital (Xiamen) Fudan University Xiamen China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital Fudan University Shanghai China
- Central Research Institute United Imaging Healthcare Shanghai China
- Department of Cancer Center, Zhongshan Hospital Fudan University Shanghai China
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Magnetic resonance elastography of the liver: everything you need to know to get started. Abdom Radiol (NY) 2022; 47:94-114. [PMID: 34725719 DOI: 10.1007/s00261-021-03324-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 12/17/2022]
Abstract
Magnetic resonance elastography (MRE) of the liver has emerged as the non-invasive standard for the evaluation of liver fibrosis in chronic liver diseases (CLDs). The utility of MRE in the evaluation of different CLD in both adults and children has been demonstrated in several studies, and MRE has been recommended by several clinical societies. Consequently, the clinical indications for evaluation of CLD with MRE have increased, and MRE is currently used as an add-on test during routine liver MRI studies or as a standalone test. To meet the increasing clinical demand, MRE is being installed in many academic and private practice imaging centers. There is a need for a comprehensive practical guide to help these practices to deliver high-quality liver MRE studies as well as troubleshoot the common issues with MRE to ensure smooth running of the service. This comprehensive clinical practice review summarizes the indications and provides an overview on why to use MRE, technical requirements, system set-up, patient preparation, acquiring the data, and interpretation.
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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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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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Guglielmo FF, Venkatesh SK, Mitchell DG. Liver MR Elastography Technique and Image Interpretation: Pearls and Pitfalls. Radiographics 2019; 39:1983-2002. [DOI: 10.1148/rg.2019190034] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Flavius F. Guglielmo
- From the Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (F.F.G., D.G.M.); and Department of Radiology, Mayo Clinic, Rochester, Minn (S.K.V.)
| | - Sudhakar K. Venkatesh
- From the Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (F.F.G., D.G.M.); and Department of Radiology, Mayo Clinic, Rochester, Minn (S.K.V.)
| | - Donald G. Mitchell
- From the Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (F.F.G., D.G.M.); and Department of Radiology, Mayo Clinic, Rochester, Minn (S.K.V.)
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