1
|
Yoon H, Kim J, Lim HJ, Lee MJ. Quantitative Liver Imaging in Children. Invest Radiol 2024:00004424-990000000-00238. [PMID: 39047265 DOI: 10.1097/rli.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
ABSTRACT In children and adults, quantitative imaging examinations determine the effectiveness of treatment for liver disease. However, pediatric liver disease differs in presentation from liver disease in adults. Children also needed to be followed for a longer period from onset and have less control of their bodies, showing more movement than adults during imaging examinations, which leads to a greater need for sedation. Thus, it is essential to appropriately tailor and accurately perform noninvasive imaging tests in these younger patients. This article is an overview of updated imaging techniques used to assess liver disease quantitatively in children. The common initial imaging study for diffuse liver disease in pediatric patients is ultrasound. In addition to preexisting echo analysis, newly developed attenuation imaging techniques have been introduced to evaluate fatty liver. Ultrasound elastography is also now actively used to evaluate liver conditions, and the broad age spectrum of the pediatric population requires caution to be taken even in the selection of probes. Magnetic resonance imaging (MRI) is another important imaging tool used to evaluate liver disease despite requiring sedation or anesthesia in young children because it allows quantitative analysis with sequences such as fat analysis and MR elastography. In addition to ultrasound and MRI, we review quantitative imaging methods specifically for fatty liver, Wilson disease, biliary atresia, hepatic fibrosis, Fontan-associated liver disease, autoimmune hepatitis, sinusoidal obstruction syndrome, and the transplanted liver. Lastly, concerns such as growth and motion that need to be addressed specifically for children are summarized.
Collapse
Affiliation(s)
- Haesung Yoon
- From the Department of Radiology, Gangnam Severance Hospital, Seoul, South Korea (H.Y.); Department of Radiology and Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, South Korea (H.Y., J.K., H.J.L., M.-J.L.); and Department of Pediatric Radiology, Severance Children's Hospital, Seoul, South Korea (J.K., H.J.L., M.-J.L.)
| | | | | | | |
Collapse
|
2
|
Kafali SG, Bolster BD, Shih SF, Delgado TI, Deshpande V, Zhong X, Adamos TR, Ghahremani S, Calkins KL, Wu HH. Self-Gated Radial Free-Breathing Liver MR Elastography: Assessment of Technical Performance in Children at 3 T. J Magn Reson Imaging 2024. [PMID: 39036994 DOI: 10.1002/jmri.29541] [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: 04/10/2024] [Revised: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Conventional liver magnetic resonance elastography (MRE) requires breath-holding (BH) to avoid motion artifacts, which is challenging for children. While radial free-breathing (FB)-MRE is an alternative for quantifying liver stiffness (LS), previous methods had limitations of long scan times, acquiring two slices in 5 minutes, and not resolving motion during reconstruction. PURPOSE To reduce FB-MRE scan time to 4 minutes for four slices and to investigate the impact of self-gated (SG) motion compensation on FB-MRE LS quantification in terms of agreement, intrasession repeatability, and technical quality compared to conventional BH-MRE. STUDY TYPE Prospective. POPULATION Twenty-six children without fibrosis (median age: 12.9 years, 15 females). FIELD STRENGTH/SEQUENCE 3 T; Cartesian gradient-echo (GRE) BH-MRE, research application radial GRE FB-MRE. ASSESSMENT Participants were scanned twice to measure repeatability, without moving the table or changing the participants' position. LS was measured in areas of the liver with numerical confidence ≥90%. Technical quality was examined using measurable liver area (%). STATISTICAL TESTS Agreement of LS between BH-MRE and FB-MRE was evaluated using Bland-Altman analysis for SG acceptance rates of 40%, 60%, 80%, and 100%. LS repeatability was assessed using within-subject coefficient of variation (wCV). The differences in LS and measurable liver area were examined using Kruskal-Wallis and Wilcoxon signed-rank tests. P < 0.05 was considered significant. RESULTS FB-MRE with 60% SG achieved the closest agreement with BH-MRE (mean difference 0.00 kPa). The LS ranged from 1.70 to 1.83 kPa with no significant differences between BH-MRE and FB-MRE with varying SG rates (P = 0.52). All tested methods produced repeatable LS with wCV from 4.4% to 6.5%. The median measurable liver area was smaller for FB-MRE (32%-45%) than that for BH-MRE (91%-93%) (P < 0.05). DATA CONCLUSION FB-MRE with 60% SG can quantify LS with close agreement and comparable repeatability with respect to BH-MRE in children. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 1.
Collapse
Affiliation(s)
- Sevgi Gokce Kafali
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Department of Bioengineering, University of California Los Angeles, Los Angeles, California, USA
| | - Bradley D Bolster
- US MR R&D Collaborations, Siemens Medical Solutions USA, Inc., Salt Lake City, Utah, USA
| | - Shu-Fu Shih
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Department of Bioengineering, University of California Los Angeles, Los Angeles, California, USA
| | - Timoteo I Delgado
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Physics and Biology in Medicine Interdepartmental Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Vibhas Deshpande
- US MR R&D Collaborations, Siemens Medical Solutions USA, Inc., Austin, Texas, USA
| | - Xiaodong Zhong
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Department of Bioengineering, University of California Los Angeles, Los Angeles, California, USA
- Physics and Biology in Medicine Interdepartmental Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Timothy R Adamos
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Shahnaz Ghahremani
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Kara L Calkins
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Holden H Wu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Department of Bioengineering, University of California Los Angeles, Los Angeles, California, USA
- Physics and Biology in Medicine Interdepartmental Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| |
Collapse
|
3
|
Roubidoux MA, Kaur JS, Rhoades DA. Health Disparities in Cancer Among American Indians and Alaska Natives. Acad Radiol 2022; 29:1013-1021. [PMID: 34802904 DOI: 10.1016/j.acra.2021.10.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/15/2021] [Accepted: 10/20/2021] [Indexed: 12/15/2022]
Abstract
American Indians and Alaska Natives (AI/AN) are underserved populations who suffer from several health disparities, 1 of which is cancer. Malignancies, especially cancers of the breast, liver, and lung, are common causes of death in this population. Health care disparities in this population include more limited access to diagnostic radiology because of geographic and/or health system limitations. Early detection of these cancers may be enabled by improving patient and physician access to medical imaging. Awareness by the radiology community of the cancer disparities among this population is needed to support research targeted to this specific ethnic group and to support outreach efforts to provide more imaging opportunities. Providing greater access to imaging facilities will also improve patient compliance with screening recommendations, ultimately improving mortality in these populations.
Collapse
Affiliation(s)
- Marilyn A Roubidoux
- Department of Radiology, Michigan Medicine, TC 2910, 1500 E. Medical Center Drive, Ann Arbor, Mi 48109-5326.
| | - Judith S Kaur
- Department of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida
| | - Dorothy A Rhoades
- Department of Internal Medicine, Stephenson Cancer Center and the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| |
Collapse
|
4
|
Automated CNN-Based Analysis Versus Manual Analysis for MR Elastography in Nonalcoholic Fatty Liver Disease: Inter-method Agreement and Fibrosis Stage Discriminative Performance. AJR Am J Roentgenol 2022; 219:224-232. [PMID: 35107306 DOI: 10.2214/ajr.21.27135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Histological fibrosis stage is the most important prognostic factor in chronic liver disease. MR elastography (MRE) is the most accurate noninvasive method for detecting and staging liver fibrosis. Although accurate, manual ROI-based MRE analysis is complex, time consuming, requires specialized readers, and prone to methodologic variability and suboptimal inter-reader agreement. Objectives: To develop an automated convolutional neural network (CNN)-based method for liver MRE analysis, evaluate its agreement with manual ROI-based analysis, and assess its discriminative performance for dichotomized fibrosis stages using histology as reference standard. Methods: In this retrospective cross-sectional study, 675 participants who underwent MRE using different MRI systems and field strengths at 28 imaging sites from five multicenter international clinical trials of nonalcoholic steatohepatitis were included for algorithm development and internal testing of agreement between automated CNN- and manual ROI-based analyses. Eighty-one patients (52 women, 29 men; mean age, 54 years) who underwent MRE using a single 3-Tesla system and liver biopsy for clinical purposes at a single institution were included for external testing of agreement and assessment of fibrosis stage discriminative performance. Agreement was evaluated using intra-class correlation coefficients (ICC). 95% CIs were computed using bootstrapping. Discriminative performance of each method for dichotomized histologic fibrosis stage was evaluated by AUC and compared using bootstrapping. Results: Mean CNN- and manual ROI-based stiffness measurements ranged from 3.21 to 3.34 kPa in trial participants and from 3.30 to 3.45 kPa in clinical patients. ICC for CNN- and manual ROI-based measurements was 0.98 (95% CI, 0.978-0.98) in trial participants and 0.99 (95% CI: 0.98-0.99) in clinical patients. AUC for classification of dichotomized fibrosis stage ranged from 0.89-0.93 for CNN- and 0.87-0.93 for manual ROI-based analyses (p=.23-.75). Conclusion: Stiffness measurements using the automated CNN-based method agreed strongly with manual ROIbased analysis across MRI systems and field strengths, with excellent discriminative performance for histology-determined dichotomized fibrosis stages in external testing. Clinical Impact: Given the high incidence of chronic liver disease worldwide, it is important that noninvasive tools to assess fibrosis are applied reliably across different settings. CNN-based analysis is feasible and may reduce reliance on expert image analysts.
Collapse
|
5
|
Kafali SG, Armstrong T, Shih SF, Kim GJ, Holtrop JL, Venick RS, Ghahremani S, Bolster BD, Hillenbrand CM, Calkins KL, Wu HH. Free-breathing radial magnetic resonance elastography of the liver in children at 3 T: a pilot study. Pediatr Radiol 2022; 52:1314-1325. [PMID: 35366073 PMCID: PMC9192470 DOI: 10.1007/s00247-022-05297-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/02/2021] [Accepted: 01/20/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Magnetic resonance (MR) elastography of the liver measures hepatic stiffness, which correlates with the histopathological staging of liver fibrosis. Conventional Cartesian gradient-echo (GRE) MR elastography requires breath-holding, which is challenging for children. Non-Cartesian radial free-breathing MR elastography is a potential solution to this problem. OBJECTIVE To investigate radial free-breathing MR elastography for measuring hepatic stiffness in children. MATERIALS AND METHODS In this prospective pilot study, 14 healthy children and 9 children with liver disease were scanned at 3 T using 2-D Cartesian GRE breath-hold MR elastography (22 s/slice) and 2-D radial GRE free-breathing MR elastography (163 s/slice). Each sequence was acquired twice. Agreement in the stiffness measurements was evaluated using Lin's concordance correlation coefficient (CCC) and within-subject mean difference. The repeatability was assessed using the within-subject coefficient of variation and intraclass correlation coefficient (ICC). RESULTS Fourteen healthy children and seven children with liver disease completed the study. Median (±interquartile range) normalized measurable liver areas were 62.6% (±26.4%) and 44.1% (±39.6%) for scan 1, and 60.3% (±21.8%) and 43.9% (±44.2%) for scan 2, for Cartesian and radial techniques, respectively. Hepatic stiffness from the Cartesian and radial techniques had close agreement with CCC of 0.89 and 0.94, and mean difference of 0.03 kPa and -0.01 kPa, for scans 1 and 2. Cartesian and radial techniques achieved similar repeatability with within-subject coefficient of variation=1.9% and 3.4%, and ICC=0.93 and 0.92, respectively. CONCLUSION In this pilot study, radial free-breathing MR elastography was repeatable and in agreement with Cartesian breath-hold MR elastography in children.
Collapse
Affiliation(s)
- Sevgi Gokce Kafali
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA 90095 USA ,Department of Bioengineering, University of California Los Angeles, Los Angeles, CA USA
| | - Tess Armstrong
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA 90095 USA
| | - Shu-Fu Shih
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA 90095 USA ,Department of Bioengineering, University of California Los Angeles, Los Angeles, CA USA
| | - Grace J. Kim
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA 90095 USA
| | - Joseph L. Holtrop
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN USA
| | - Robert S. Venick
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
| | - Shahnaz Ghahremani
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA 90095 USA
| | | | - Claudia M. Hillenbrand
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN USA ,Research Imaging NSW, University of New South Wales, Sydney, Australia
| | - Kara L. Calkins
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
| | - Holden H. Wu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA 90095 USA ,Department of Bioengineering, University of California Los Angeles, Los Angeles, CA USA
| |
Collapse
|
6
|
Assessing the progression of segmental fibrosis in chronic liver disease using extracellular volume fractions. Eur J Radiol 2021; 145:110033. [PMID: 34808581 DOI: 10.1016/j.ejrad.2021.110033] [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: 07/28/2021] [Revised: 10/02/2021] [Accepted: 11/12/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE To assess the segmental difference of liver fibrosis during the progression of chronic liver disease (CLD) using hepatic extracellular volume fractions (fECVs) obtained by dual-energy CT. METHODS A total of 218 patients (92 men and 126 women; mean age, 67.8 ± 11.7 years) with CLD and 85 patients (44 men and 41 women; mean age, 62.8 ± 13.7 years) without CLD as a control underwent dual-energy computed tomography (CT) of the liver (5-min equilibrium phase images). The iodine densities of the lateral, medial, anterior, and posterior segments and the aorta were measured, and fECVs were calculated. Comparisons of the fECV of each segment and for each albumin-bilirubin (ALBI) grade were then statistically analyzed. RESULTS In the control group and ALBI grades 1 and 3, no significant difference in fECV was found between each segment, whereas in ALBI grade 2, the fECVs were significantly larger in the medial and anterior than in the other segments (p < 0.001). The fECVs of the lateral and posterior segments significantly increased with higher ALBI grade (p < 0.001). The fECVs of the medial and anterior segments were significantly increased with higher ALBI grade, up to grade 2 (p < 0.001), but no significant difference was found between ALBI grades 2 and 3. CONCLUSION During the progression of CLD, fibrosis antecedently progressed in the medial and anterior segments, followed by the other liver segments.
Collapse
|
7
|
Matos J, Paparo F, Bacigalupo L, Cenderello G, Mussetto I, De Cesari M, Bernardi SP, Cevasco L, Forni GL, Cassola G, Rollandi GA. Noninvasive liver fibrosis assessment in chronic viral hepatitis C: agreement among 1D transient elastography, 2D shear wave elastography, and magnetic resonance elastography. Abdom Radiol (NY) 2019; 44:4011-4021. [PMID: 31696266 DOI: 10.1007/s00261-019-02295-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To assess the agreement of one-dimensional transient elastography (1D-TE), two-dimensional shear wave elastography (2D-SWE), and magnetic resonance elastography (MRE) in a consecutive cohort of patients affected by hepatitis C virus (HCV) and to understand which patient-related factors are associated with disagreement. METHODS Ninety-one consecutive patients with current or previous chronic HCV infection were enrolled between March 2017 and September 2018. We assessed the correlation between stiffness measurements expressed in kilopascals (kPa). After converting kPa values in three groups of increasing fibrosis burden using validated cut-off values, we assessed the agreement among the different techniques. Factors influencing inter-modality disagreement were examined by employing multivariate logistic regression analysis. RESULTS Seventy-seven patients met the inclusion criteria and had reliable measurements by all stiffness imaging techniques. At the quantitative analysis, a strong correlation between stiffness measurements was found (Spearman's rho values ranging from 0.7 to 0.89 in all pairs of techniques). Complete concordance among MRE, 1D-TE, and 2D-SWE was found in 64.9% of patients, and the agreement was highest between MRE and 1D-TE, with κ value of 0.801. In only 2/77 patients (2.6%), there was complete disagreement. High body mass index (BMI) was the only factor significantly associated with inter-modality discordance. CONCLUSIONS MRE, 1D-TE, and 2D-SWE assigned the majority of patients to the same fibrosis group. The agreement was at least good, and there was a strong correlation between kPa values in all three pairs of techniques. Highest agreement was found between MRE and 1D-TE. High BMI was associated with discordance among the techniques.
Collapse
Affiliation(s)
- João Matos
- Unit of Radiology, Department of Diagnostic Imaging, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy.
- DISSAL - Department of Health Sciences, University of Genoa, Via Antonio Pastore, 1, 16132, Genoa, Italy.
| | - Francesco Paparo
- Unit of Radiology, Department of Diagnostic Imaging, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Lorenzo Bacigalupo
- Unit of Radiology, Department of Diagnostic Imaging, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Giovanni Cenderello
- Unit of Infectious Diseases, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Ilaria Mussetto
- DISSAL - Department of Health Sciences, University of Genoa, Via Antonio Pastore, 1, 16132, Genoa, Italy
| | - Matteo De Cesari
- DISSAL - Department of Health Sciences, University of Genoa, Via Antonio Pastore, 1, 16132, Genoa, Italy
| | - Silvia Perugin Bernardi
- Unit of Radiology, Department of Diagnostic Imaging, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Luca Cevasco
- Unit of Radiology, Department of Diagnostic Imaging, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Gian Luca Forni
- Unit of Microcitemia and Hereditary Anemias, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Giovanni Cassola
- Unit of Infectious Diseases, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Gian Andrea Rollandi
- Unit of Radiology, Department of Diagnostic Imaging, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| |
Collapse
|