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Sgier D, Stocker D, Jüngst C, Renzulli M, Biletska-Hanchorova H, Weber A, Kannengiesser S, Gubler C, Reiner CS. Feasibility and performance of spin-echo EPI MR elastography at 3 Tesla for staging hepatic fibrosis in the presence of hepatic iron overload. Abdom Radiol (NY) 2024:10.1007/s00261-023-04160-0. [PMID: 38990302 DOI: 10.1007/s00261-023-04160-0] [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: 09/05/2023] [Revised: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 07/12/2024]
Abstract
PURPOSE To assess the feasibility and performance of MR elastography (MRE) for quantifying liver fibrosis in patients with and without hepatic iron overload. METHODS This retrospective single-center study analyzed 139 patients who underwent liver MRI at 3 Tesla including MRE (2D spin-echo EPI sequence) and R2* mapping for liver iron content (LIC) estimation. MRE feasibility and diagnostic performance between patients with normal and elevated LIC were compared. RESULTS Patients with elevated LIC (21%) had significantly higher MRE failure rates (24.1% vs. 3.6%, p < 0.001) compared to patients with normal LIC (79%). For those with only insignificant to mild iron overload (LIC < 5.4 mg/g; 17%), MRE failure rate did not differ significantly from patients without iron overload (8.3% vs. 3.6%, p = 0.315). R2* predicted MRE failure with fair accuracy at a threshold of R2* ≥ 269 s-1 (LIC of approximately 4.6 mg/g). MRE showed good diagnostic performance for detecting significant (≥ F2) and severe fibrosis (≥ F3) in patients without (AUC 0.835 and 0.900) and with iron overload (AUC 0.818 and 0.889) without significant difference between the cohorts (p = 0.884 and p = 0.913). For detecting cirrhosis MRE showed an excellent diagnostic performance in both groups (AUC 0.944 and 1.000, p = 0.009). CONCLUSION Spin-echo EPI MRE at 3 Tesla is feasible in patients with mild iron overload with good to excellent performance for detecting hepatic fibrosis with a failure rate comparable to patients without iron overload.
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Affiliation(s)
- David Sgier
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Daniel Stocker
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Christoph Jüngst
- University of Zurich, Zurich, Switzerland
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Melanie Renzulli
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Hanna Biletska-Hanchorova
- University of Zurich, Zurich, Switzerland
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Achim Weber
- University of Zurich, Zurich, Switzerland
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | | | - Christoph Gubler
- Department of Gastroenterology and Hepatology, Stadtspital Triemli, Zurich, Switzerland
| | - Caecilia S Reiner
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
- University of Zurich, Zurich, Switzerland.
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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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Cobilinschi CO, Săulescu I, Caraiola S, Nițu AF, Dumitru RL, Husar-Sburlan I, Bălănescu AR, Opriș-Belinski D. A "Mix and Match" in Hemochromatosis-A Case Report and Literature Focus on the Liver. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1586. [PMID: 37763705 PMCID: PMC10534457 DOI: 10.3390/medicina59091586] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023]
Abstract
Hemochromatosis is a genetic disorder characterized by increased iron storage in various organs with progressive multisystemic damage. Despite the reports dating back to 1865, the diagnosis of hemochromatosis poses a challenge to clinicians due to its non-specific symptoms and indolent course causing significant delay in disease recognition. The key organ that is affected by iron overload is the liver, suffering from fibrosis, cirrhosis or hepatocellular carcinoma, complications that can be prevented via early diagnosis and treatment. This review aims to draw attention to the pitfalls in diagnosing hemochromatosis. We present a case with multiorgan complaints, abnormal iron markers and a consistent genetic result. We then examine the relevant literature and discuss hemochromatosis subtypes and liver involvement, including transplant outcome and treatment options. In summary, hemochromatosis remains difficult to diagnose due to its symptom heterogeneity and rarity; thus, further education for practitioners of all disciplines is useful in facilitating its early recognition and management.
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Affiliation(s)
- Claudia Oana Cobilinschi
- Department of Rheumatology and Internal Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.O.C.); (I.S.); (S.C.); (A.R.B.); (D.O.-B.)
- Department of Rheumatology and Internal Medicine, Sfânta Maria Clinical Hospital Bucharest, 011172 Bucharest, Romania
| | - Ioana Săulescu
- Department of Rheumatology and Internal Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.O.C.); (I.S.); (S.C.); (A.R.B.); (D.O.-B.)
- Department of Rheumatology and Internal Medicine, Sfânta Maria Clinical Hospital Bucharest, 011172 Bucharest, Romania
| | - Simona Caraiola
- Department of Rheumatology and Internal Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.O.C.); (I.S.); (S.C.); (A.R.B.); (D.O.-B.)
- Department of Internal Medicine, Colentina Clinical Hospital, Bucharest, 020125 Bucharest, Romania
| | - Andra Florina Nițu
- Department of Radiology and Medical Imaging, Sf Maria Clinical Hospital Bucharest, 011172 Bucharest, Romania;
| | - Radu Lucian Dumitru
- Department of Rheumatology and Internal Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.O.C.); (I.S.); (S.C.); (A.R.B.); (D.O.-B.)
- Department of Radiology and Medical Imaging, Sf Maria Clinical Hospital Bucharest, 011172 Bucharest, Romania;
| | - Ioana Husar-Sburlan
- Department of Gastroenterology, Sf Maria Clinical Hospital Bucharest, 011172 Bucharest, Romania;
| | - Andra Rodica Bălănescu
- Department of Rheumatology and Internal Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.O.C.); (I.S.); (S.C.); (A.R.B.); (D.O.-B.)
- Department of Rheumatology and Internal Medicine, Sfânta Maria Clinical Hospital Bucharest, 011172 Bucharest, Romania
| | - Daniela Opriș-Belinski
- Department of Rheumatology and Internal Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.O.C.); (I.S.); (S.C.); (A.R.B.); (D.O.-B.)
- Department of Rheumatology and Internal Medicine, Sfânta Maria Clinical Hospital Bucharest, 011172 Bucharest, Romania
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Obrzut M, Atamaniuk V, Ehman RL, Yin M, Cholewa M, Gutkowski K, Domka W, Ozga D, Obrzut B. Evaluation of Spleen Stiffness in Young Healthy Volunteers Using Magnetic Resonance Elastography. Diagnostics (Basel) 2023; 13:2738. [PMID: 37685274 PMCID: PMC10486410 DOI: 10.3390/diagnostics13172738] [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: 07/19/2023] [Revised: 08/16/2023] [Accepted: 08/20/2023] [Indexed: 09/10/2023] Open
Abstract
PURPOSE Magnetic resonance elastography (MRE) has been established as the most accurate noninvasive technique for diagnosing liver fibrosis. Recent publications have suggested that the measurement of splenic stiffness is useful in setting where portal hypertension may be present. The goal of the current study was to compile normative data for MRE-assessed stiffness measurements of the spleen in young adults. MATERIALS AND METHODS A total of 100 healthy young Caucasian volunteers (65 females and 35 males) in the age range of 20 to 32 years were enrolled in this study. The participants reported no history of chronic spleen and liver disease, normal alcohol consumption, and a normal diet. The MRE data were acquired by using a 1.5 T whole-body scanner and a 2D GRE pulse sequence with 60 Hz excitation. Spleen stiffness was calculated as a weighted mean of stiffness values in the regions of interest manually drawn by the radiologist on three to five spleen slices. RESULTS Mean spleen stiffness was 5.09 ± 0.65 kPa for the whole group. Male volunteers had slightly higher splenic stiffness compared to females: 5.28 ± 0.78 vs. 4.98 ± 0.51 kPa, however, this difference was not statistically significant (p = 0.12). Spleen stiffness did not correlate with spleen fat content and liver stiffness but a statistically significant correlation with spleen volume was found. CONCLUSIONS The findings of this study provide normative values for 2D MRE-based measurement of spleen stiffness in young adults, a basis for assessing the value of this biomarker in young patients with portal system pathologies.
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Affiliation(s)
- Marzanna Obrzut
- Institute of Health Sciences, Medical College, University of Rzeszow, Warzywna 1a, 35-310 Rzeszow, Poland; (M.O.)
| | - Vitaliy Atamaniuk
- Department of Biophysics, Institute of Physics, College of Natural Sciences, University of Rzeszow, Prof. Stanisława Pigonia Str. 1, 35-310 Rzeszow, Poland; (V.A.); (M.C.)
| | - Richard L. Ehman
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Meng Yin
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Marian Cholewa
- Department of Biophysics, Institute of Physics, College of Natural Sciences, University of Rzeszow, Prof. Stanisława Pigonia Str. 1, 35-310 Rzeszow, Poland; (V.A.); (M.C.)
| | - Krzysztof Gutkowski
- Institute of Medical Sciences, Medical College, University of Rzeszow, Rejtana 16C, 35-959 Rzeszow, Poland;
| | - Wojciech Domka
- Department of Otolaryngology, Institute of Medical Sciences, Medical College, University of Rzeszow, Rejtana 16C, 35-959 Rzeszow, Poland;
| | - Dorota Ozga
- Institute of Health Sciences, Medical College, University of Rzeszow, Warzywna 1a, 35-310 Rzeszow, Poland; (M.O.)
| | - Bogdan Obrzut
- Department of Obstetrics and Gynecology, Institute of Medical Sciences, Medical College, University of Rzeszow, Rejtana 16C, 35-959 Rzeszow, Poland
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Mohammed S, Kozlowski P, Salcudean S. Phase-regularized and displacement-regularized compressed sensing for fast magnetic resonance elastography. NMR IN BIOMEDICINE 2023; 36:e4899. [PMID: 36628624 DOI: 10.1002/nbm.4899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/12/2022] [Accepted: 01/01/2023] [Indexed: 06/15/2023]
Abstract
Liver magnetic resonance elastography (MRE) is a noninvasive stiffness measurement technique that captures the tissue displacement in the phase of the signal. To limit the scanning time to a single breath-hold, liver MRE usually involves advanced readout techniques such as simultaneous multislice (SMS) or multishot methods. Furthermore, all these readout techniques require additional in-plane acceleration using either parallel imaging capabilities, such as sensitivity encoding (SENSE), or k -space undersampling, such as compressed sensing (CS). However, these methods apply a single regularization function on the complex image. This study aims to design and evaluate methods that use separate regularization on the magnitude and phase of MRE to exploit their distinct spatiotemporal characteristics. Specifically, we introduce two compressed sensing methods. The first method, termed phase-regularized compressed sensing (PRCS), applies a two-dimensional total variation (TV) prior to the magnitude and two-dimensional wavelet regularization to the phase. The second method, termed displacement-regularized compressed sensing (DRCS), exploits the spatiotemporal redundancy using 3D total variation on the magnitude. Additionally, DRCS includes a displacement fitting function to apply wavelet regularization to the displacement phasor. Both DRCS and PRCS were evaluated with different levels of compression factors in three datasets: an in silico abdomen dataset, an in vitro tissue-mimicking phantom, and an in vivo liver dataset. The reconstructed images were compared with the full sampled reconstruction, zero-filling reconstruction, wavelet-regularized compressed sensing, and a low rank plus sparse reconstruction. The metrics used for quantitative evaluation were the structural similarity index (SSIM) of magnitude (M-SSIM), displacement (D-SSIM), and shear modulus (S-SSIM), and mean shear modulus. Results from highly undersampled in silico and in vitro datasets demonstrate that the DRCS method provides higher reconstruction quality than the conventional compressed sensing method for a wide range of stiffness values. Notably, DRCS provides 24% and 22% increase in D-SSIM compared with CS for the in silico and in vitro datasets, respectively. Comparison with liver stiffness measured from full sampled data and highly undersampled data (CR=4) demonstrates that the DRCS method provided the strongest correlation ( R 2 =0.95), second-lowest mean bias (-0.18 kPa, lowest for CS with -0.16 kPa), and lowest coefficient of variation (CV=3.6%). Our results demonstrate the potential of using DRCS to improve the reconstruction quality of accelerated MRE.
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Affiliation(s)
- Shahed Mohammed
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, Canada
| | - Piotr Kozlowski
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Septimiu Salcudean
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, Canada
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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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Pednekar A, Gandhi D, Wang H, Tkach JA, Trout AT, Dillman JR. Performance of C-SENSE Accelerated Rapid Liver Shear Stiffness Measurement Using Displacement Wave Polarity-Inversion Motion Encoding: An Evaluation Study. J Magn Reson Imaging 2022; 56:754-765. [PMID: 35089614 DOI: 10.1002/jmri.28078] [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: 11/01/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Liver shear stiffness measurement using magnetic resonance elastography (MRE) aids in the noninvasive diagnosis and staging of liver fibrosis. Inadequate breath-holds can lead to inaccurate stiffness estimation and/or failed MRE exams. PURPOSE To prospectively evaluate the performance of compressed sensitivity encoding (C-SENSE) accelerated rapid MRE measurement of liver shear stiffness using displacement wave polarity-inversion motion encoding. STUDY TYPE Retrospective. SUBJECTS Eleven with liver disease and 10 asymptomatic subjects. FIELD STRENGTH/SEQUENCE 1.5 T; gradient-recalled-echo (GRE) MRE. ASSESSMENT All participants underwent: 1) two-dimensional (2D) GRE MRE with inflow saturation using SENSE acceleration factor (R) of 2 (standard of care [SC]); 2) 2D rapid MRE with (RwS); and 3) without (RnS) inflow saturation using C-SENSE R = 3; and 4) spatial three-dimensional (3D) rapid MRE with inflow saturation (R3D) using C-SENSE R = 4; with nominally identical spatial resolution and coverage. Image analyst (D.G., 2 years of experience) drew identical and maximal regions of interest (ROIs) in right hepatic lobe. STATISTICAL TESTS Linear regression, intra-class correlation coefficients (ICC), Bland-Altman analyses, and the Wilcoxon signed-rank test were used to assess consistency and agreement of liver stiffness measurements for manually drawn identical and maximal ROIs. RESULTS In 21 participants (37 ± 14 years) with liver stiffness (2.3 ± 0.7 kPa), body mass index (BMI 27 ± 7 kg/m2 ), proton density fat fraction (PDFF 9 ± 9%), and T2 * (27 ± 4 msec); rapid MRE sequences showed excellent agreement (ICC > 0.95) with SC MRE and no correlation (r2 < 0.1) of the differences (mean difference <0.2 kPa, <6%; limits of agreement <0.4 kPa, <16%) with BMI, PDFF, and T2 *. Breath-hold times were: 14 seconds (SC), 5 seconds (RnS), 7 seconds (RwS) per slice, and 16 seconds for the R3D acquisition. DATA CONCLUSIONS C-SENSE accelerated GRE MRE sequences, using displacement wave polarity-inversion motion encoding, produce equivalent measurements of liver stiffness and have potential clinical benefit in patients with limited breath-holding capacity. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- 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
| | - Deep Gandhi
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Hui Wang
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,MR Clinical Science, Philips, 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
| | - 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
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