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Ozkaya E, Kennedy P, Chen J, Bane O, Dillman JR, Jhaveri KS, Ohliger MA, Rossman PJ, Tkach JA, Doucette JT, Venkatesh SK, Ehman RL, Taouli B. Precision and Test-Retest Repeatability of Stiffness Measurement with MR Elastography: A Multicenter Phantom Study. Radiology 2024; 311:e233136. [PMID: 38742971 PMCID: PMC11140535 DOI: 10.1148/radiol.233136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 03/14/2024] [Accepted: 03/26/2024] [Indexed: 05/16/2024]
Abstract
Background MR elastography (MRE) has been shown to have excellent performance for noninvasive liver fibrosis staging. However, there is limited knowledge regarding the precision and test-retest repeatability of stiffness measurement with MRE in the multicenter setting. Purpose To determine the precision and test-retest repeatability of stiffness measurement with MRE across multiple centers using the same phantoms. Materials and Methods In this study, three cylindrical phantoms made of polyvinyl chloride gel mimicking different degrees of liver stiffness in humans (phantoms 1-3: soft, medium, and hard stiffness, respectively) were evaluated. Between January 2021 and January 2022, phantoms were circulated between five different centers and scanned with 10 MRE-equipped clinical 1.5-T and 3-T systems from three major vendors, using two-dimensional (2D) gradient-recalled echo (GRE) imaging and/or 2D spin-echo (SE) echo-planar imaging (EPI). Similar MRE acquisition parameters, hardware, and reconstruction algorithms were used at each center. Mean stiffness was measured by a single observer for each phantom and acquisition on a single section. Stiffness measurement precision and same-session test-retest repeatability were assessed using the coefficient of variation (CV) and the repeatability coefficient (RC), respectively. Results The mean precision represented by the CV was 5.8% (95% CI: 3.8, 7.7) for all phantoms and both sequences combined. For all phantoms, 2D GRE achieved a CV of 4.5% (95% CI: 3.3, 5.7) whereas 2D SE EPI achieved a CV of 7.8% (95% CI: 3.1, 12.6). The mean RC of stiffness measurement was 5.8% (95% CI: 3.7, 7.8) for all phantoms and both sequences combined, 4.9% (95% CI: 2.7, 7.0) for 2D GRE, and 7.0% (95% CI: 2.9, 11.2) for 2D SE EPI (all phantoms). Conclusion MRE had excellent in vitro precision and same-session test-retest repeatability in the multicenter setting when similar imaging protocols, hardware, and reconstruction algorithms were used. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Tang in this issue.
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Affiliation(s)
| | | | - Jun Chen
- From the BioMedical Engineering and Imaging Institute (E.O., P.K.,
O.B., B.T.) and Departments of Diagnostic, Molecular and Interventional
Radiology (E.O., P.K., O.B., B.T.) Environmental Medicine and Public Health
(J.T.D.), Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York,
NY 10029; Department of Radiology, Mayo Clinic, Rochester, Minn (J.C., P.J.R.,
S.K.V., R.L.E.); Department of Radiology, Nanjing University Medical School
Affiliated Drum Tower Hospital, Nanjing, China (J.C.); Department of Radiology,
Cincinnati Children’s Hospital Medical Center, University of Cincinnati
College of Medicine, Cincinnati, Ohio (J.R.D., J.A.T.); Joint Department of
Medical Imaging, University Health Network, Mount Sinai Hospital, and
Women’s College Hospital, University of Toronto, Toronto, Canada
(K.S.J.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, Calif (M.A.O.); and Department of Radiology,
Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.)
| | - Octavia Bane
- From the BioMedical Engineering and Imaging Institute (E.O., P.K.,
O.B., B.T.) and Departments of Diagnostic, Molecular and Interventional
Radiology (E.O., P.K., O.B., B.T.) Environmental Medicine and Public Health
(J.T.D.), Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York,
NY 10029; Department of Radiology, Mayo Clinic, Rochester, Minn (J.C., P.J.R.,
S.K.V., R.L.E.); Department of Radiology, Nanjing University Medical School
Affiliated Drum Tower Hospital, Nanjing, China (J.C.); Department of Radiology,
Cincinnati Children’s Hospital Medical Center, University of Cincinnati
College of Medicine, Cincinnati, Ohio (J.R.D., J.A.T.); Joint Department of
Medical Imaging, University Health Network, Mount Sinai Hospital, and
Women’s College Hospital, University of Toronto, Toronto, Canada
(K.S.J.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, Calif (M.A.O.); and Department of Radiology,
Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.)
| | - Jonathan R. Dillman
- From the BioMedical Engineering and Imaging Institute (E.O., P.K.,
O.B., B.T.) and Departments of Diagnostic, Molecular and Interventional
Radiology (E.O., P.K., O.B., B.T.) Environmental Medicine and Public Health
(J.T.D.), Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York,
NY 10029; Department of Radiology, Mayo Clinic, Rochester, Minn (J.C., P.J.R.,
S.K.V., R.L.E.); Department of Radiology, Nanjing University Medical School
Affiliated Drum Tower Hospital, Nanjing, China (J.C.); Department of Radiology,
Cincinnati Children’s Hospital Medical Center, University of Cincinnati
College of Medicine, Cincinnati, Ohio (J.R.D., J.A.T.); Joint Department of
Medical Imaging, University Health Network, Mount Sinai Hospital, and
Women’s College Hospital, University of Toronto, Toronto, Canada
(K.S.J.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, Calif (M.A.O.); and Department of Radiology,
Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.)
| | - Kartik S. Jhaveri
- From the BioMedical Engineering and Imaging Institute (E.O., P.K.,
O.B., B.T.) and Departments of Diagnostic, Molecular and Interventional
Radiology (E.O., P.K., O.B., B.T.) Environmental Medicine and Public Health
(J.T.D.), Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York,
NY 10029; Department of Radiology, Mayo Clinic, Rochester, Minn (J.C., P.J.R.,
S.K.V., R.L.E.); Department of Radiology, Nanjing University Medical School
Affiliated Drum Tower Hospital, Nanjing, China (J.C.); Department of Radiology,
Cincinnati Children’s Hospital Medical Center, University of Cincinnati
College of Medicine, Cincinnati, Ohio (J.R.D., J.A.T.); Joint Department of
Medical Imaging, University Health Network, Mount Sinai Hospital, and
Women’s College Hospital, University of Toronto, Toronto, Canada
(K.S.J.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, Calif (M.A.O.); and Department of Radiology,
Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.)
| | - Michael A. Ohliger
- From the BioMedical Engineering and Imaging Institute (E.O., P.K.,
O.B., B.T.) and Departments of Diagnostic, Molecular and Interventional
Radiology (E.O., P.K., O.B., B.T.) Environmental Medicine and Public Health
(J.T.D.), Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York,
NY 10029; Department of Radiology, Mayo Clinic, Rochester, Minn (J.C., P.J.R.,
S.K.V., R.L.E.); Department of Radiology, Nanjing University Medical School
Affiliated Drum Tower Hospital, Nanjing, China (J.C.); Department of Radiology,
Cincinnati Children’s Hospital Medical Center, University of Cincinnati
College of Medicine, Cincinnati, Ohio (J.R.D., J.A.T.); Joint Department of
Medical Imaging, University Health Network, Mount Sinai Hospital, and
Women’s College Hospital, University of Toronto, Toronto, Canada
(K.S.J.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, Calif (M.A.O.); and Department of Radiology,
Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.)
| | - Phillip J. Rossman
- From the BioMedical Engineering and Imaging Institute (E.O., P.K.,
O.B., B.T.) and Departments of Diagnostic, Molecular and Interventional
Radiology (E.O., P.K., O.B., B.T.) Environmental Medicine and Public Health
(J.T.D.), Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York,
NY 10029; Department of Radiology, Mayo Clinic, Rochester, Minn (J.C., P.J.R.,
S.K.V., R.L.E.); Department of Radiology, Nanjing University Medical School
Affiliated Drum Tower Hospital, Nanjing, China (J.C.); Department of Radiology,
Cincinnati Children’s Hospital Medical Center, University of Cincinnati
College of Medicine, Cincinnati, Ohio (J.R.D., J.A.T.); Joint Department of
Medical Imaging, University Health Network, Mount Sinai Hospital, and
Women’s College Hospital, University of Toronto, Toronto, Canada
(K.S.J.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, Calif (M.A.O.); and Department of Radiology,
Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.)
| | - Jean A. Tkach
- From the BioMedical Engineering and Imaging Institute (E.O., P.K.,
O.B., B.T.) and Departments of Diagnostic, Molecular and Interventional
Radiology (E.O., P.K., O.B., B.T.) Environmental Medicine and Public Health
(J.T.D.), Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York,
NY 10029; Department of Radiology, Mayo Clinic, Rochester, Minn (J.C., P.J.R.,
S.K.V., R.L.E.); Department of Radiology, Nanjing University Medical School
Affiliated Drum Tower Hospital, Nanjing, China (J.C.); Department of Radiology,
Cincinnati Children’s Hospital Medical Center, University of Cincinnati
College of Medicine, Cincinnati, Ohio (J.R.D., J.A.T.); Joint Department of
Medical Imaging, University Health Network, Mount Sinai Hospital, and
Women’s College Hospital, University of Toronto, Toronto, Canada
(K.S.J.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, Calif (M.A.O.); and Department of Radiology,
Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.)
| | - John T. Doucette
- From the BioMedical Engineering and Imaging Institute (E.O., P.K.,
O.B., B.T.) and Departments of Diagnostic, Molecular and Interventional
Radiology (E.O., P.K., O.B., B.T.) Environmental Medicine and Public Health
(J.T.D.), Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York,
NY 10029; Department of Radiology, Mayo Clinic, Rochester, Minn (J.C., P.J.R.,
S.K.V., R.L.E.); Department of Radiology, Nanjing University Medical School
Affiliated Drum Tower Hospital, Nanjing, China (J.C.); Department of Radiology,
Cincinnati Children’s Hospital Medical Center, University of Cincinnati
College of Medicine, Cincinnati, Ohio (J.R.D., J.A.T.); Joint Department of
Medical Imaging, University Health Network, Mount Sinai Hospital, and
Women’s College Hospital, University of Toronto, Toronto, Canada
(K.S.J.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, Calif (M.A.O.); and Department of Radiology,
Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.)
| | - Sudhakar K. Venkatesh
- From the BioMedical Engineering and Imaging Institute (E.O., P.K.,
O.B., B.T.) and Departments of Diagnostic, Molecular and Interventional
Radiology (E.O., P.K., O.B., B.T.) Environmental Medicine and Public Health
(J.T.D.), Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York,
NY 10029; Department of Radiology, Mayo Clinic, Rochester, Minn (J.C., P.J.R.,
S.K.V., R.L.E.); Department of Radiology, Nanjing University Medical School
Affiliated Drum Tower Hospital, Nanjing, China (J.C.); Department of Radiology,
Cincinnati Children’s Hospital Medical Center, University of Cincinnati
College of Medicine, Cincinnati, Ohio (J.R.D., J.A.T.); Joint Department of
Medical Imaging, University Health Network, Mount Sinai Hospital, and
Women’s College Hospital, University of Toronto, Toronto, Canada
(K.S.J.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, Calif (M.A.O.); and Department of Radiology,
Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.)
| | - Richard L. Ehman
- From the BioMedical Engineering and Imaging Institute (E.O., P.K.,
O.B., B.T.) and Departments of Diagnostic, Molecular and Interventional
Radiology (E.O., P.K., O.B., B.T.) Environmental Medicine and Public Health
(J.T.D.), Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York,
NY 10029; Department of Radiology, Mayo Clinic, Rochester, Minn (J.C., P.J.R.,
S.K.V., R.L.E.); Department of Radiology, Nanjing University Medical School
Affiliated Drum Tower Hospital, Nanjing, China (J.C.); Department of Radiology,
Cincinnati Children’s Hospital Medical Center, University of Cincinnati
College of Medicine, Cincinnati, Ohio (J.R.D., J.A.T.); Joint Department of
Medical Imaging, University Health Network, Mount Sinai Hospital, and
Women’s College Hospital, University of Toronto, Toronto, Canada
(K.S.J.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, Calif (M.A.O.); and Department of Radiology,
Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.)
| | - Bachir Taouli
- From the BioMedical Engineering and Imaging Institute (E.O., P.K.,
O.B., B.T.) and Departments of Diagnostic, Molecular and Interventional
Radiology (E.O., P.K., O.B., B.T.) Environmental Medicine and Public Health
(J.T.D.), Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York,
NY 10029; Department of Radiology, Mayo Clinic, Rochester, Minn (J.C., P.J.R.,
S.K.V., R.L.E.); Department of Radiology, Nanjing University Medical School
Affiliated Drum Tower Hospital, Nanjing, China (J.C.); Department of Radiology,
Cincinnati Children’s Hospital Medical Center, University of Cincinnati
College of Medicine, Cincinnati, Ohio (J.R.D., J.A.T.); Joint Department of
Medical Imaging, University Health Network, Mount Sinai Hospital, and
Women’s College Hospital, University of Toronto, Toronto, Canada
(K.S.J.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, Calif (M.A.O.); and Department of Radiology,
Zuckerberg San Francisco General Hospital, San Francisco, Calif (M.A.O.)
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Low G, Ferguson C, Locas S, Tu W, Manolea F, Sam M, Wilson MP. Multiparametric MR assessment of liver fat, iron, and fibrosis: a concise overview of the liver "Triple Screen". Abdom Radiol (NY) 2023; 48:2060-2073. [PMID: 37041393 DOI: 10.1007/s00261-023-03887-0] [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: 02/05/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 04/13/2023]
Abstract
Chronic liver disease (CLD) is a common source of morbidity and mortality worldwide. Non-alcoholic fatty liver disease (NAFLD) serves as a major cause of CLD with a rising annual prevalence. Additionally, iron overload can be both a cause and effect of CLD with a negative synergistic effect when combined with NAFLD. The development of state-of-the-art multiparametric MR solutions has led to a change in the diagnostic paradigm in CLD, shifting from traditional liver biopsy to innovative non-invasive methods for providing accurate and reliable detection and quantification of the disease burden. Novel imaging biomarkers such as MRI-PDFF for fat, R2 and R2* for iron, and liver stiffness for fibrosis provide important information for diagnosis, surveillance, risk stratification, and treatment. In this article, we provide a concise overview of the MR concepts and techniques involved in the detection and quantification of liver fat, iron, and fibrosis including their relative strengths and limitations and discuss a practical abbreviated MR protocol for clinical use that integrates these three MR biomarkers into a single simplified MR assessment. Multiparametric MR techniques provide accurate and reliable non-invasive detection and quantification of liver fat, iron, and fibrosis. These techniques can be combined in a single abbreviated MR "Triple Screen" assessment to offer a more complete metabolic imaging profile of CLD.
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Affiliation(s)
- Gavin Low
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, WMC 2B2.41 8440-112 ST, Edmonton, AB, T6G2B7, Canada
| | - Craig Ferguson
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, WMC 2B2.41 8440-112 ST, Edmonton, AB, T6G2B7, Canada
| | - Stephanie Locas
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, WMC 2B2.41 8440-112 ST, Edmonton, AB, T6G2B7, Canada
| | - Wendy Tu
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, WMC 2B2.41 8440-112 ST, Edmonton, AB, T6G2B7, Canada
| | - Florin Manolea
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, WMC 2B2.41 8440-112 ST, Edmonton, AB, T6G2B7, Canada
| | - Medica Sam
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, WMC 2B2.41 8440-112 ST, Edmonton, AB, T6G2B7, Canada
| | - Mitchell P Wilson
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, WMC 2B2.41 8440-112 ST, Edmonton, AB, T6G2B7, Canada.
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Song Q, Shi Y, Gao F, Yin M, Yang R, Liu Y, Zhong S, Hong Y. Feasibility and Reproducibility of Multifrequency Magnetic Resonance Elastography in Healthy and Diseased Pancreases. J Magn Reson Imaging 2022; 56:1769-1780. [PMID: 35332973 PMCID: PMC9509497 DOI: 10.1002/jmri.28158] [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: 01/20/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The feasibility and reproducibility of multifrequency MR elastography (MRE) for diagnosing pancreatic ductal adenocarcinoma (PDAC) have not been reported. PURPOSE To determine the feasibility and reproducibility of multifrequency MRE for assessing pancreatic stiffness in healthy and diseased pancreases. STUDY TYPE Prospective. SUBJECTS A total of 40 healthy volunteers and 10 patients with PDAC were prospectively recruited between March 2018 and October 2021. FIELD STRENGTH/SEQUENCE A 3.0-T pancreatic MRE at frequencies in the order of 30, 40, 60, 80, and 100 Hz. ASSESSMENT Body mass index (BMI) and wave distance of the healthy pancreas and PDAC were measured. Image quality was assessed using the image quality score (IQS: 1-4, ≥3 were considered diagnostic quality). Three readers independently performed the pancreatic stiffness and IQS assessments to evaluate reproducibility. STATISTICAL TESTS Logistic regression analyses were performed to determine variables that influenced IQS. Statistical significance was set at P <0.05. Levels of inter- and intrarater agreement were assessed using intraclass correlation coefficients (ICC) and Cohen's kappa coefficient (κ). Good reproducibility was set at ICC and κ ≥ 0.8. RESULTS In logistic regression analysis, a diagnostic IQS in healthy volunteers was independently associated with a lower BMI (odds ratio [OR] = 0.89 kg/m-2 ), shorter wave distance (OR = 0.70 cm-1 ), and lower frequency (30 and 40 Hz: OR = 170.01 and 96.02). In PDAC, frequency was the only independent factor for diagnostic IQS (30-60 Hz: OR = 46.18, 46.18, and 17.20, respectively) with 100 Hz as a reference. In healthy volunteers, good reproducibility was observed at 30 and 40 Hz. In PDAC, good reproducibility was observed at 30-60 Hz. DATA CONCLUSION MRE at 30 and 40 Hz provides diagnostic wave images and reliable measurements of pancreatic stiffness in healthy volunteers. MRE at 30-60 Hz is acceptable for PDACs (IQS ≥ 3, ICC and κ ≥ 0.80). EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Qike Song
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Yu Shi
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Feng Gao
- Department of Pancreato-thyroidic Surgery, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Meng Yin
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Rui Yang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Yuanyuan Liu
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Shiling Zhong
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Yang Hong
- Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, P.R. China
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Kafali SG, Armstrong T, Shih SF, Kim GJ, Holtrop JL, Venick RS, Ghahremani S, Bolster BD, Hillenbrand CM, Calkins KL, Wu HH. Free-breathing radial magnetic resonance elastography of the liver in children at 3 T: a pilot study. Pediatr Radiol 2022; 52:1314-1325. [PMID: 35366073 PMCID: PMC9192470 DOI: 10.1007/s00247-022-05297-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/02/2021] [Accepted: 01/20/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Magnetic resonance (MR) elastography of the liver measures hepatic stiffness, which correlates with the histopathological staging of liver fibrosis. Conventional Cartesian gradient-echo (GRE) MR elastography requires breath-holding, which is challenging for children. Non-Cartesian radial free-breathing MR elastography is a potential solution to this problem. OBJECTIVE To investigate radial free-breathing MR elastography for measuring hepatic stiffness in children. MATERIALS AND METHODS In this prospective pilot study, 14 healthy children and 9 children with liver disease were scanned at 3 T using 2-D Cartesian GRE breath-hold MR elastography (22 s/slice) and 2-D radial GRE free-breathing MR elastography (163 s/slice). Each sequence was acquired twice. Agreement in the stiffness measurements was evaluated using Lin's concordance correlation coefficient (CCC) and within-subject mean difference. The repeatability was assessed using the within-subject coefficient of variation and intraclass correlation coefficient (ICC). RESULTS Fourteen healthy children and seven children with liver disease completed the study. Median (±interquartile range) normalized measurable liver areas were 62.6% (±26.4%) and 44.1% (±39.6%) for scan 1, and 60.3% (±21.8%) and 43.9% (±44.2%) for scan 2, for Cartesian and radial techniques, respectively. Hepatic stiffness from the Cartesian and radial techniques had close agreement with CCC of 0.89 and 0.94, and mean difference of 0.03 kPa and -0.01 kPa, for scans 1 and 2. Cartesian and radial techniques achieved similar repeatability with within-subject coefficient of variation=1.9% and 3.4%, and ICC=0.93 and 0.92, respectively. CONCLUSION In this pilot study, radial free-breathing MR elastography was repeatable and in agreement with Cartesian breath-hold MR elastography in children.
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Affiliation(s)
- Sevgi Gokce Kafali
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA 90095 USA ,Department of Bioengineering, University of California Los Angeles, Los Angeles, CA USA
| | - Tess Armstrong
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA 90095 USA
| | - Shu-Fu Shih
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA 90095 USA ,Department of Bioengineering, University of California Los Angeles, Los Angeles, CA USA
| | - Grace J. Kim
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA 90095 USA
| | - Joseph L. Holtrop
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN USA
| | - Robert S. Venick
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
| | - Shahnaz Ghahremani
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA 90095 USA
| | | | - Claudia M. Hillenbrand
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN USA ,Research Imaging NSW, University of New South Wales, Sydney, Australia
| | - Kara L. Calkins
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
| | - Holden H. Wu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 300 UCLA Medical Plaza, Suite B119, Los Angeles, CA 90095 USA ,Department of Bioengineering, University of California Los Angeles, Los Angeles, CA USA
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A novel technique for automating stiffness measurement and emphasizing the main wave: Coherent-wave auto-selection (CHASE). Magn Reson Imaging 2021; 85:133-140. [PMID: 34687851 DOI: 10.1016/j.mri.2021.10.032] [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: 02/11/2021] [Revised: 05/17/2021] [Accepted: 10/17/2021] [Indexed: 11/20/2022]
Abstract
This study aims to develop and assess a new automated processing technique in MR elastography (MRE), namely coherent-wave auto-selection (CHASE). CHASE enables automatic selection of the region of interest (ROI) for stiffness measurement by extraction of the coherent wave region (CHASE ROI), and it improves the reconstruction of stiffness by a directional filter oriented along the main wave in each pixel (CHASE filtering). In this study, MRE of a phantom and of the liver of four healthy volunteers was performed. To investigate the potential of CHASE, this study assessed the CHASE according to three indices through the phantom study: 1) agreement on the ROI settings between CHASE and expert observers, 2) noise dependency, and 3) effect of the CHASE on stiffness variability within the CHASE ROI. The agreements on the ROI settings were analyzed by Cohen's kappa coefficient (κ). The noise dependency was analyzed by the mean absolute percentage errors (MAPEs) within the ROI between low (20%-80% amplitudes) and high vibration amplitudes (100% amplitude). The stiffness variability was assessed by standard deviation (SD) within the ROI. In the volunteer study, agreements on the ROI settings (or stiffness value) and stiffness variability within the CHASE ROI were assessed using κ-value (or intraclass correlation coefficient: ICC) and coefficient of variation, respectively. The results showed close agreement on the ROI settings and stiffness (κ-value: greater than 0.61 in both the phantom and volunteer studies, ICC: 0.97 in the volunteer study). The MAPEs within the CHASE ROI were much smaller than those in the whole region of the phantom (CHASE ROI vs. the whole region at 20% amplitude: 10.3% vs. 50.8%). Moreover, in both the phantom and volunteer studies, the stiffness variation within the CHASE ROI was smaller in the elastogram processed with CHASE filtering than in the unprocessed one. Our results demonstrated that the CHASE has high robustness against noise and the potential to provide ROI settings for stiffness measurement comparable to expert observers, as well as improve the reconstruction of stiffness.
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Ito D, Numano T, Ueki T, Habe T, Maeno T, Takamoto K, Igarashi K, Maharjan S, Mizuhara K, Nishijo H. Magnetic resonance elastography of the supraspinatus muscle: A preliminary study on test-retest repeatability and wave quality with different frequencies and image filtering. Magn Reson Imaging 2020; 71:27-36. [PMID: 32325234 DOI: 10.1016/j.mri.2020.04.009] [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: 09/22/2019] [Revised: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 12/17/2022]
Abstract
The purpose of this study was to determine an optimal condition (vibration frequency and image filtering) for stiffness estimation with high accuracy and stiffness measurement with high repeatability in magnetic resonance elastography (MRE) of the supraspinatus muscle. Nine healthy volunteers underwent two MRE exams separated by at least a 30 min break, on the same day. MRE acquisitions were performed with a gradient-echo type multi-echo MR sequence at 75, 100, and 125 Hz pneumatic vibration. Wave images were processed by a bandpass filter or filter combining bandpass and directional filters (bandpass-directional filter). An observer specified the region of interest (ROI) on clear wave propagation in the supraspinatus muscle, within which the observer measured the stiffness. This study assessed wave image quality according to two indices, as a substitute for the assessment of the accuracy of the stiffness estimation. One is the size of the clear wave propagation area (ROI size used to measure the stiffness) and the other is the qualitative stiffness resolution score in that area. These measurements made by the observer were repeated twice at least one month apart after each MRE exam. This study assessed the intra-examiner and observer repeatability of the stiffness value, ROI size and resolution score in each combination of vibration frequency and image filter. Repeatability of the data was analyzed using the intraclass correlation coefficient (ICC) and 95% limits-of-agreement (LOA) in Bland-Altman analysis. The analyses on intra-examiner and observer repeatability of stiffness indicated that the ICC and 95% LOA were not varied greatly depending on vibration frequency and image filter (intra-examiner repeatability, ICC range, 0.79 to 0.88; 95% LOA range, ±23.95 to ±32.42%, intra-observer repeatability, ICC range, 0.98 to 1.00; 95% LOA range, ±5.10 to ±10.99%). In the analyses on intra-examiner repeatability of ROI size, ICCs were rather low (ranging from: 0.03 to 0.69) while 95% LOA was large in all the combinations of vibration frequency and image filter (ranging from: ±62.66 to ±83.33%). In the analyses on intra-observer repeatability of ROI size, ICCs were sufficiently high in the total combination of vibration frequency and image filter (ranging from 0.80 to 0.87) while the 95% LOAs were better (lower) in the bandpass-directional filter than the bandpass filter (bandpass directional filter vs. bandpass filter, ±28.81 vs. ±54.83% at 75 Hz; ±25.63 vs. ±37.83% at 100 Hz; ±34.51 vs. ±43.36% at 125 Hz). In the analyses on intra-examiner and observer repeatability of resolution score, the mean difference (bias) between the two exams (or observations) was significantly low and there was almost no difference across all the combinations of vibration frequency and image filter (range of bias: -0.11-0.11 and -0.17-0.00, respectively). Additionally, effects of vibration frequency and image filter on wave image quality (ROI size and resolution score) were assessed separately in each exam. Both mean ROI size and resolution score in the bandpass-directional filter were larger than those in the bandpass filter. Among the data in the bandpass-directional filter, mean ROI size was larger at 75 and 100 Hz, and mean resolution score was larger at 100 and 125 Hz. Taking into consideration with the results of repeatability and wave image quality, the present results suggest that optimal vibration frequency and image filter for MRE of the supraspinatus muscles is 100 Hz and bandpass-directional filter, respectively.
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Affiliation(s)
- Daiki Ito
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10, Higashiogu, Arakawa-ku, Tokyo 116-8551, Japan; Office of Radiation Technology, Keio University Hospital, Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; Health Research Institute, National Institute of Advanced Industrial Science and Technology, 1-2-1, Namiki, Tsukuba-shi, Ibaraki 305-8564, Japan
| | - Tomokazu Numano
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10, Higashiogu, Arakawa-ku, Tokyo 116-8551, Japan; Health Research Institute, National Institute of Advanced Industrial Science and Technology, 1-2-1, Namiki, Tsukuba-shi, Ibaraki 305-8564, Japan.
| | - Takamichi Ueki
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10, Higashiogu, Arakawa-ku, Tokyo 116-8551, Japan
| | - Tetsushi Habe
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10, Higashiogu, Arakawa-ku, Tokyo 116-8551, Japan; Office of Radiation Technology, Keio University Hospital, Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Toshiki Maeno
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10, Higashiogu, Arakawa-ku, Tokyo 116-8551, Japan
| | - Kouichi Takamoto
- Department of Sport and Health Sciences, Faculty of Human Sciences, University of East Asia, 2-1, Ichinomiyagakuen-cho, Shimonoseki-shi, Yamaguchi 751-8503, Japan; System Emotional Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630, Sugitani, Toyama 930-0194, Japan
| | - Keisuke Igarashi
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10, Higashiogu, Arakawa-ku, Tokyo 116-8551, Japan
| | - Surendra Maharjan
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10, Higashiogu, Arakawa-ku, Tokyo 116-8551, Japan
| | - Kazuyuki Mizuhara
- Health Research Institute, National Institute of Advanced Industrial Science and Technology, 1-2-1, Namiki, Tsukuba-shi, Ibaraki 305-8564, Japan; Department of Mechanical Engineering, Tokyo Denki University, 5, Senju Asahicho, Adachi-ku, Tokyo 120-8551, Japan
| | - Hisao Nishijo
- System Emotional Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630, Sugitani, Toyama 930-0194, Japan
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Saito S. [7. Reproducibility of Liver Magnetic Resonance Elastography (MRE) Measurement and Its Affecting Factors]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2019; 75:1484-1490. [PMID: 31866649 DOI: 10.6009/jjrt.2019_jsrt_75.12.1484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Shigeyoshi Saito
- Department of Medical Physics and Engineering, Division of Health Sciences, Osaka University Graduate School of Medicine.,Department of Biomedical Imaging, National Cardiovascular and Cerebral Research Center
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8
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Garteiser P, Doblas S, Van Beers BE. Magnetic resonance elastography of liver and spleen: Methods and applications. NMR IN BIOMEDICINE 2018; 31:e3891. [PMID: 29369503 DOI: 10.1002/nbm.3891] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/16/2017] [Accepted: 12/04/2017] [Indexed: 05/06/2023]
Abstract
The viscoelastic properties of the liver and spleen can be assessed with magnetic resonance elastography (MRE). Several actuators, MRI acquisition sequences and reconstruction algorithms have been proposed for this purpose. Reproducible results are obtained, especially when the examination is performed in standard conditions with the patient fasting. Accurate staging of liver fibrosis can be obtained by measuring liver stiffness or elasticity with MRE. Moreover, emerging evidence shows that assessing the tissue viscous parameters with MRE is useful for characterizing liver inflammation, non-alcoholic steatohepatitis, hepatic congestion, portal hypertension, and hepatic tumors. Further advances such as multifrequency acquisitions and compression-sensitive MRE may provide novel quantitative markers of hepatic and splenic mechanical properties that may improve the diagnosis of hepatic and splenic diseases.
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Affiliation(s)
- Philippe Garteiser
- Laboratory of Imaging Biomarkers, Center of Research on Inflammation, UMR 1149 INSERM-University Paris Diderot, Paris, France
| | - Sabrina Doblas
- Laboratory of Imaging Biomarkers, Center of Research on Inflammation, UMR 1149 INSERM-University Paris Diderot, Paris, France
| | - Bernard E Van Beers
- Laboratory of Imaging Biomarkers, Center of Research on Inflammation, UMR 1149 INSERM-University Paris Diderot, Paris, France
- Department of Radiology, Beaujon University Hospital Paris Nord, Clichy, France
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9
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Kolipaka A, Wassenaar PA, Cha S, Marashdeh WM, Mo X, Kalra P, Gans B, Raterman B, Bourekas E. Magnetic resonance elastography to estimate brain stiffness: Measurement reproducibility and its estimate in pseudotumor cerebri patients. Clin Imaging 2018; 51:114-122. [PMID: 29459315 PMCID: PMC6087505 DOI: 10.1016/j.clinimag.2018.02.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 01/08/2018] [Accepted: 02/02/2018] [Indexed: 01/01/2023]
Abstract
This study determines the reproducibility of magnetic resonance elastography (MRE) derived brain stiffness in normal volunteers and compares it against pseudotumor patients before and after lumbar puncture (LP). MRE was performed on 10 normal volunteers for reproducibility and 14 pseudotumor patients before and after LP. During LP, opening and closing cerebrospinal fluid (CSF) pressures were recorded before and after removal of CSF and correlated to brain stiffness. Stiffness reproducibility was observed (r > 0.78; p < 0.008). Whole brain opening LP stiffness was significantly (p = 0.04) higher than normals, but no significant difference (p = 0.11) in closing LP measurements. No significant correlation was observed between opening and closing pressure and brain stiffness.
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Affiliation(s)
- Arunark Kolipaka
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Peter A Wassenaar
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sangmin Cha
- Electrical and Computer Engineering, The Ohio State University, Columbus, OH, USA
| | - Wael M Marashdeh
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Xiaokui Mo
- Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Prateek Kalra
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Bradley Gans
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Brian Raterman
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Eric Bourekas
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Bae JS, Lee JM, Park SJ, Lee KB, Han JK. Magnetic resonance elastography of healthy livers at 3.0 T: Normal liver stiffness measured by SE-EPI and GRE. Eur J Radiol 2018; 107:46-53. [PMID: 30292272 DOI: 10.1016/j.ejrad.2018.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/10/2018] [Accepted: 08/13/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine the normal liver stiffness values using magnetic resonance elastography (MRE) at 3.0 T and to compare spin-echo echo-planar imaging (SE-EPI) and gradient-recalled-echo (GRE) MRE. MATERIALS AND METHODS This retrospective study included 54 living liver donors who had normal clinical and pathological results without underlying liver disease and underwent MRE using both SE-EPI and GRE at 3.0 T. Two radiologists placed four or six freehand regions of interest (ROI) on the elastograms and measured liver stiffness as well as the area of ROIs. The mean liver stiffness values and area of ROIs were compared between genders, among age groups, and between groups of different body mass indexes using the t-test and one-way analysis of variance, respectively. Interobserver agreement was analyzed using intraclass correlation coefficient. The mean liver stiffness values and area of ROIs were compared between SE-EPI and GRE using the paired t-test and Bland-Altman analysis. RESULTS The liver stiffness values in living liver donors ranged from 1.52 to 3.12 kPa on SE-EPI and 1.51 to 2.67 kPa on GRE. The mean liver stiffness values did not differ significantly according to the gender, age, and body mass index. Measurement of liver stiffness using MRE showed excellent interobserver agreement on both pulse sequences. The mean value of liver stiffness was higher on SE-EPI (2.14 ± 0.33 kPa) than on GRE (2.06 ± 0.25 kPa), and the difference was statistically significant (P < 0.05). The mean area of ROI was significantly larger with GRE (3387 mm2) than with SE-EPI (2691 mm2) (P < 0.05). CONCLUSIONS The mean liver stiffness values in living donors measured by SE-EPI and GRE were not affected by gender, age, or body mass index and showed excellent interobserver agreement. The area of ROI was larger with GRE than with SE-EPI.
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Affiliation(s)
- Jae Seok Bae
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Sae-Jin Park
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Kyung Bun Lee
- Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
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11
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Kennedy P, Wagner M, Castéra L, Hong CW, Johnson CL, Sirlin CB, Taouli B. Quantitative Elastography Methods in Liver Disease: Current Evidence and Future Directions. Radiology 2018; 286:738-763. [PMID: 29461949 DOI: 10.1148/radiol.2018170601] [Citation(s) in RCA: 186] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic liver diseases often result in the development of liver fibrosis and ultimately, cirrhosis. Treatment strategies and prognosis differ greatly depending on the severity of liver fibrosis, thus liver fibrosis staging is clinically relevant. Traditionally, liver biopsy has been the method of choice for fibrosis evaluation. Because of liver biopsy limitations, noninvasive methods have become a key research interest in the field. Elastography enables the noninvasive measurement of tissue mechanical properties through observation of shear-wave propagation in the tissue of interest. Increasing fibrosis stage is associated with increased liver stiffness, providing a discriminatory feature that can be exploited by elastographic methods. Ultrasonographic (US) and magnetic resonance (MR) imaging elastographic methods are commercially available, each with their respective strengths and limitations. Here, the authors review the technical basis, acquisition techniques, and results and limitations of US- and MR-based elastography techniques. Diagnostic performance in the most common etiologies of chronic liver disease will be presented. Reliability, reproducibility, failure rate, and emerging advances will be discussed. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Paul Kennedy
- From the Translational and Molecular Imaging Institute (P.K., B.T.) and Department of Radiology (B.T.), Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York, NY 10029; Department of Radiology, Sorbonne Universités, UPMC, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.W.); Department of Hepatology, University Paris-VII, Hôpital Beaujon, Clichy, France (L.C.); Liver Imaging Group, Department of Radiology, University of California-San Diego, San Diego, Calif (C.W.H., C.B.S.); Department of Biomedical Engineering, University of Delaware, Newark, Del (C.L.J.)
| | - Mathilde Wagner
- From the Translational and Molecular Imaging Institute (P.K., B.T.) and Department of Radiology (B.T.), Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York, NY 10029; Department of Radiology, Sorbonne Universités, UPMC, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.W.); Department of Hepatology, University Paris-VII, Hôpital Beaujon, Clichy, France (L.C.); Liver Imaging Group, Department of Radiology, University of California-San Diego, San Diego, Calif (C.W.H., C.B.S.); Department of Biomedical Engineering, University of Delaware, Newark, Del (C.L.J.)
| | - Laurent Castéra
- From the Translational and Molecular Imaging Institute (P.K., B.T.) and Department of Radiology (B.T.), Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York, NY 10029; Department of Radiology, Sorbonne Universités, UPMC, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.W.); Department of Hepatology, University Paris-VII, Hôpital Beaujon, Clichy, France (L.C.); Liver Imaging Group, Department of Radiology, University of California-San Diego, San Diego, Calif (C.W.H., C.B.S.); Department of Biomedical Engineering, University of Delaware, Newark, Del (C.L.J.)
| | - Cheng William Hong
- From the Translational and Molecular Imaging Institute (P.K., B.T.) and Department of Radiology (B.T.), Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York, NY 10029; Department of Radiology, Sorbonne Universités, UPMC, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.W.); Department of Hepatology, University Paris-VII, Hôpital Beaujon, Clichy, France (L.C.); Liver Imaging Group, Department of Radiology, University of California-San Diego, San Diego, Calif (C.W.H., C.B.S.); Department of Biomedical Engineering, University of Delaware, Newark, Del (C.L.J.)
| | - Curtis L Johnson
- From the Translational and Molecular Imaging Institute (P.K., B.T.) and Department of Radiology (B.T.), Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York, NY 10029; Department of Radiology, Sorbonne Universités, UPMC, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.W.); Department of Hepatology, University Paris-VII, Hôpital Beaujon, Clichy, France (L.C.); Liver Imaging Group, Department of Radiology, University of California-San Diego, San Diego, Calif (C.W.H., C.B.S.); Department of Biomedical Engineering, University of Delaware, Newark, Del (C.L.J.)
| | - Claude B Sirlin
- From the Translational and Molecular Imaging Institute (P.K., B.T.) and Department of Radiology (B.T.), Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York, NY 10029; Department of Radiology, Sorbonne Universités, UPMC, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.W.); Department of Hepatology, University Paris-VII, Hôpital Beaujon, Clichy, France (L.C.); Liver Imaging Group, Department of Radiology, University of California-San Diego, San Diego, Calif (C.W.H., C.B.S.); Department of Biomedical Engineering, University of Delaware, Newark, Del (C.L.J.)
| | - Bachir Taouli
- From the Translational and Molecular Imaging Institute (P.K., B.T.) and Department of Radiology (B.T.), Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York, NY 10029; Department of Radiology, Sorbonne Universités, UPMC, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.W.); Department of Hepatology, University Paris-VII, Hôpital Beaujon, Clichy, France (L.C.); Liver Imaging Group, Department of Radiology, University of California-San Diego, San Diego, Calif (C.W.H., C.B.S.); Department of Biomedical Engineering, University of Delaware, Newark, Del (C.L.J.)
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12
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Wang K, Manning P, Szeverenyi N, Wolfson T, Hamilton G, Middleton MS, Vaida F, Yin M, Glaser K, Ehman RL, Sirlin CB. Repeatability and reproducibility of 2D and 3D hepatic MR elastography with rigid and flexible drivers at end-expiration and end-inspiration in healthy volunteers. Abdom Radiol (NY) 2017; 42:2843-2854. [PMID: 28612163 DOI: 10.1007/s00261-017-1206-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To evaluate the repeatability and reproducibility of 2D and 3D hepatic MRE with rigid and flexible drivers at end-expiration and end-inspiration in healthy volunteers. MATERIALS AND METHODS Nine healthy volunteers underwent two same-day MRE exams separated by a 5- to 10-min break. In each exam, 2D and 3D MRE scans were performed, each under four conditions (2 driver types [rigid, flexible] × 2 breath-hold phases [end-expiration, end-inspiration]). Repeatability (measurements under identical conditions) and reproducibility (measurements under different conditions) were analyzed by calculating bias, limit of agreement, repeatability coefficient (RC), reproducibility coefficient (RDC), intraclass correlation coefficient (ICC), and concordance correlation coefficient (CCC), as appropriate. RESULTS For 2D MRE, RCs and ICCs range between 0.29-0.49 and 0.71-0.91, respectively. For 3D MRE, RCs and ICCs range between 0.16-0.26 and 0.84-0.96, respectively. Stiffness values were biased by breath-hold phase, being higher at end-inspiration than end-expiration, and the differences were significant for 3D MRE (p < 0.01). No bias was found between driver types. Inspiration vs. expiration RDCs and CCCs ranged between 0.30-0.54 and 0.61-0.72, respectively. Rigid vs. flexible driver RDCs and CCCs ranged between 0.10-0.44 and 0.79-0.94, respectively. CONCLUSION This preliminary study suggests that 2D MRE and 3D MRE under most conditions potentially have good repeatability. Our result also points to the possibility that stiffness measured with the rigid and flexible drivers is reproducible. Reproducibility between breath-hold phases was modest, suggesting breath-hold phase might be a confounding factor in MRE-based stiffness measurement. However, larger studies are required to validate these preliminary results.
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Magnetic Resonance Elastography of the Liver: Qualitative and Quantitative Comparison of Gradient Echo and Spin Echo Echoplanar Imaging Sequences. Invest Radiol 2017; 51:575-81. [PMID: 26982699 DOI: 10.1097/rli.0000000000000269] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of this study was to compare 2-dimensional (2D) gradient recalled echo (GRE) and 2D spin echo echoplanar imaging (SE-EPI) magnetic resonance elastography (MRE) sequences of the liver in terms of image quality and quantitative liver stiffness (LS) measurement. MATERIALS AND METHODS This prospective study involved 50 consecutive subjects (male/female, 33/17; mean age, 58 years) who underwent liver magnetic resonance imaging at 3.0 T including 2 MRE sequences, 2D GRE, and 2D SE-EPI (acquisition time 56 vs 16 seconds, respectively). Image quality scores were assessed by 2 independent observers based on wave propagation and organ coverage on the confidence map (range, 0-15). A third observer measured LS on stiffness maps (in kilopascal). Mean LS values, regions of interest size (based on confidence map), and image quality scores between SE-EPI and GRE-MRE were compared using paired nonparametric Wilcoxon test. Reproducibility of LS values between the 2 sequences was assessed using intraclass coefficient correlation, coefficient of variation, and Bland-Altman limits of agreement. T2* effect on image quality was assessed using partial Spearman correlation. RESULTS There were 4 cases of failure with GRE-MRE and none with SE-EPI-MRE. Image quality scores and region of interest size were significantly higher using SE-EPI-MRE versus GRE-MRE (P < 0.0001 for both measurements and observers). Liver stiffness measurements were not significantly different between the 2 sequences (3.75 ± 1.87 kPa vs 3.55 ± 1.51 kPa, P = 0.062), were significantly correlated (intraclass coefficient correlation, 0.909), and had excellent reproducibility (coefficient of variation, 10.2%; bias, 0.023; Bland-Altman limits of agreement, -1.19; 1.66 kPa). Image quality scores using GRE-MRE were significantly correlated with T2* while there was no correlation for SE-EPI-MRE. CONCLUSIONS Our data suggest that SE-EPI-MRE may be a better alternative to GRE-MRE. The diagnostic performance of SE-EPI-MRE for detection of liver fibrosis needs to be assessed in a future study.
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Serai SD, Obuchowski NA, Venkatesh SK, Sirlin CB, Miller FH, Ashton E, Cole PE, Ehman RL. Repeatability of MR Elastography of Liver: A Meta-Analysis. Radiology 2017; 285:92-100. [PMID: 28530847 DOI: 10.1148/radiol.2017161398] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose To perform a meta-analysis to generate an estimate of the repeatability coefficient (RC) for magnetic resonance (MR) elastography of the liver. Materials and Methods A systematic search of databases was performed for publications on MR elastography during the 10-year period between 2006 and 2015. The identified studies were screened independently and were verified reciprocally by all authors. Two reviewers independently determined the percentage RC and effective sample size from each article. A forest plot was constructed of the percentage RC estimates from the 12 studies. Bootstrap 95% confidence intervals (CIs) were constructed for the summary percentage RCs. Results Twelve studies comprising 274 patients met the eligibility criteria and were included for analysis. A flow diagram of studies included according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was prepared for the inclusion and exclusion criteria. All studies included in the meta-analysis fulfilled four or more of the seven categories of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2. The estimated summary RC was 22% (95% CI: 16.1%, 28.2%). The three main sources for this heterogeneity were the trained versus untrained operator drawing contours to choose regions of interest, the time between two replicate examinations, and, finally, the field strength of the MR imaging unit. The RC estimates tended to be higher for studies that did not use a well-trained operator, those with 1.5-T field strength imaging units, and those with longer time intervals between examinations. Conclusion The meta-analysis results provide the basis for the following draft longitudinal Quantitative Imaging Biomarkers Alliance MR elastography claim: A measured change in hepatic stiffness of 22% or greater, at the same site and with use of the same equipment and acquisition sequence, indicates that a true change in stiffness has occurred with 95% confidence. © RSNA, 2017.
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Affiliation(s)
- Suraj D Serai
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229 (S.D.S.); Department of Quantitative Health Sciences, the Cleveland Clinic Foundation, Cleveland, Ohio (N.A.O.); Department of Radiology, Mayo Clinic, Rochester, Minn (S.K.V., R.L.E.); Department of Radiology, UCSD Liver Imaging Group, San Diego, Calif (C.B.S.); Department of Radiology, Northwestern Memorial Hospital, Chicago, Ill (F.H.M.); Virtualscopics, Rochester, NY (E.A.); and Clinical and Translational Science-Imaging, Takeda Pharmaceuticals, Deerfield, Ill (P.E.C.)
| | - Nancy A Obuchowski
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229 (S.D.S.); Department of Quantitative Health Sciences, the Cleveland Clinic Foundation, Cleveland, Ohio (N.A.O.); Department of Radiology, Mayo Clinic, Rochester, Minn (S.K.V., R.L.E.); Department of Radiology, UCSD Liver Imaging Group, San Diego, Calif (C.B.S.); Department of Radiology, Northwestern Memorial Hospital, Chicago, Ill (F.H.M.); Virtualscopics, Rochester, NY (E.A.); and Clinical and Translational Science-Imaging, Takeda Pharmaceuticals, Deerfield, Ill (P.E.C.)
| | - Sudhakar K Venkatesh
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229 (S.D.S.); Department of Quantitative Health Sciences, the Cleveland Clinic Foundation, Cleveland, Ohio (N.A.O.); Department of Radiology, Mayo Clinic, Rochester, Minn (S.K.V., R.L.E.); Department of Radiology, UCSD Liver Imaging Group, San Diego, Calif (C.B.S.); Department of Radiology, Northwestern Memorial Hospital, Chicago, Ill (F.H.M.); Virtualscopics, Rochester, NY (E.A.); and Clinical and Translational Science-Imaging, Takeda Pharmaceuticals, Deerfield, Ill (P.E.C.)
| | - Claude B Sirlin
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229 (S.D.S.); Department of Quantitative Health Sciences, the Cleveland Clinic Foundation, Cleveland, Ohio (N.A.O.); Department of Radiology, Mayo Clinic, Rochester, Minn (S.K.V., R.L.E.); Department of Radiology, UCSD Liver Imaging Group, San Diego, Calif (C.B.S.); Department of Radiology, Northwestern Memorial Hospital, Chicago, Ill (F.H.M.); Virtualscopics, Rochester, NY (E.A.); and Clinical and Translational Science-Imaging, Takeda Pharmaceuticals, Deerfield, Ill (P.E.C.)
| | - Frank H Miller
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229 (S.D.S.); Department of Quantitative Health Sciences, the Cleveland Clinic Foundation, Cleveland, Ohio (N.A.O.); Department of Radiology, Mayo Clinic, Rochester, Minn (S.K.V., R.L.E.); Department of Radiology, UCSD Liver Imaging Group, San Diego, Calif (C.B.S.); Department of Radiology, Northwestern Memorial Hospital, Chicago, Ill (F.H.M.); Virtualscopics, Rochester, NY (E.A.); and Clinical and Translational Science-Imaging, Takeda Pharmaceuticals, Deerfield, Ill (P.E.C.)
| | - Edward Ashton
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229 (S.D.S.); Department of Quantitative Health Sciences, the Cleveland Clinic Foundation, Cleveland, Ohio (N.A.O.); Department of Radiology, Mayo Clinic, Rochester, Minn (S.K.V., R.L.E.); Department of Radiology, UCSD Liver Imaging Group, San Diego, Calif (C.B.S.); Department of Radiology, Northwestern Memorial Hospital, Chicago, Ill (F.H.M.); Virtualscopics, Rochester, NY (E.A.); and Clinical and Translational Science-Imaging, Takeda Pharmaceuticals, Deerfield, Ill (P.E.C.)
| | - Patricia E Cole
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229 (S.D.S.); Department of Quantitative Health Sciences, the Cleveland Clinic Foundation, Cleveland, Ohio (N.A.O.); Department of Radiology, Mayo Clinic, Rochester, Minn (S.K.V., R.L.E.); Department of Radiology, UCSD Liver Imaging Group, San Diego, Calif (C.B.S.); Department of Radiology, Northwestern Memorial Hospital, Chicago, Ill (F.H.M.); Virtualscopics, Rochester, NY (E.A.); and Clinical and Translational Science-Imaging, Takeda Pharmaceuticals, Deerfield, Ill (P.E.C.)
| | - Richard L Ehman
- From the Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229 (S.D.S.); Department of Quantitative Health Sciences, the Cleveland Clinic Foundation, Cleveland, Ohio (N.A.O.); Department of Radiology, Mayo Clinic, Rochester, Minn (S.K.V., R.L.E.); Department of Radiology, UCSD Liver Imaging Group, San Diego, Calif (C.B.S.); Department of Radiology, Northwestern Memorial Hospital, Chicago, Ill (F.H.M.); Virtualscopics, Rochester, NY (E.A.); and Clinical and Translational Science-Imaging, Takeda Pharmaceuticals, Deerfield, Ill (P.E.C.)
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15
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Ichikawa S, Motosugi U, Enomoto N, Matsuda M, Onishi H. Noninvasive hepatic fibrosis staging using mr elastography: The usefulness of the bayesian prediction method. J Magn Reson Imaging 2016; 46:375-382. [DOI: 10.1002/jmri.25551] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/26/2016] [Indexed: 12/11/2022] Open
Affiliation(s)
| | - Utaroh Motosugi
- Department of Radiology; University of Yamanashi; Yamanashi Japan
| | - Nobuyuki Enomoto
- First Department of Internal Medicine; University of Yamanashi; Yamanashi Japan
| | - Masanori Matsuda
- First Department of Surgery; University of Yamanashi; Yamanashi Japan
| | - Hiroshi Onishi
- Department of Radiology; University of Yamanashi; Yamanashi Japan
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16
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Li G, Xu Z, Yuan W, Chang S, Chen Y, Calimente H, Hu J. Short- and midterm reproducibility of marrow fat measurements using mDixon imaging in healthy postmenopausal women. Skeletal Radiol 2016; 45:1385-90. [PMID: 27502625 DOI: 10.1007/s00256-016-2448-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/05/2016] [Accepted: 07/26/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We tested the short- and midterm reproducibility of vertebral marrow fat fraction (FF) measurements using mDixon imaging. MATERIALS AND METHODS Thirty postmenopausal women underwent mDixon scans to obtain L1-4 FF from three slices per vertebra by two independent observers (session 1). Measurements were repeated after 6 weeks (session 2) and 6 months (session 3). The mean FF for three regions of interest per vertebra was calculated. The coefficients of variation (CVs) were calculated for each participant and imaging session, and the intraclass correlation coefficients (ICCs) were calculated to assess interobserver and intersession agreements. RESULTS There were no significant differences in FF measurements among the three slices, imaging sessions or observers. The mean intrasubject CV for FF measurement reproducibility was 1.94 %. The interobserver agreement for the average FF value was excellent (ICC ≥0.945 for each session). The ICC for intersession agreement was excellent (ICC ≥0.955 between sessions). The mean intersession CV was lower within a short-term interval (2.97 %) than within sessions 1 and 3 (4.80 %) or sessions 3 and 2 (4.44 %). The overall mean CV for the reproducibility of FF measured with mDixon imaging over the short- and midterm was 4.09 % (95 % CI, 3.79-4.40 %). CONCLUSION mDixon is a reproducible method for FF quantification over short- and midterm intervals up to 6 months in healthy postmenopausal women. Our results also provide data by which a power analysis can be optimized when designing studies involving the use of FF derived from similar mDixon sequences.
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Affiliation(s)
- Guanwu Li
- Department of Radiology, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Rd, Hongkou District, Shanghai, 200437, China.
| | - Zheng Xu
- Xinzhuang Community Health Center, Shanghai, 201199, China
| | - Wei Yuan
- Department of Spinal Disease Unit, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Shixin Chang
- Department of Radiology, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Rd, Hongkou District, Shanghai, 200437, China
| | - Yongsheng Chen
- Department of Radiology, Wayne State University, Detroit, 48202, MI, USA
| | - Horea Calimente
- Department of Radiology, Wayne State University, Detroit, 48202, MI, USA
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, 48202, MI, USA
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17
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Test–retest reliability of 3D EPI MR elastography of the pancreas. Clin Radiol 2016; 71:1068.e7-1068.e12. [DOI: 10.1016/j.crad.2016.03.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 03/05/2016] [Accepted: 03/23/2016] [Indexed: 12/23/2022]
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18
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Trout AT, Serai S, Mahley AD, Wang H, Zhang Y, Zhang B, Dillman JR. Liver Stiffness Measurements with MR Elastography: Agreement and Repeatability across Imaging Systems, Field Strengths, and Pulse Sequences. Radiology 2016; 281:793-804. [PMID: 27285061 DOI: 10.1148/radiol.2016160209] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose To prospectively assess agreement and repeatability of magnetic resonance (MR) elastography liver stiffness measurements across imager manufacturers, field strengths, and pulse sequences. Materials and Methods This prospective cross-sectional study was approved by the institutional review board; informed consent was obtained from all subjects. On the basis of an a priori power calculation, 24 volunteer adult subjects underwent MR elastography with four MR imaging systems (two vendors) and multiple pulse sequences (two-dimensional [2D] gradient-echo [GRE] imaging, 2D spin-echo [SE] echo-planar imaging, and three-dimensional [3D] SE echo-planar imaging). Each sequence was performed twice in each patient with each imaging system. Intraclass correlation coefficients (ICCs) were used to assess agreement and repeatability. P < .05 was considered indicative of a statistically significant difference. Results Pairwise ICCs were 0.67-0.82 and 0.62-0.83 for agreement between pulse sequences across manufacturers (n = 4) and field strengths (n = 5), respectively. ICCs were 0.45-0.90 for pairwise agreement between sequences while fixing manufacturer and field strength (n = 8). Test-retest repeatability across the various manufacturer, field strength, and pulse sequence combinations (n = 10) was excellent (ICCs, 0.77-0.94). The overall ICC for all manufacturer, field strength, and sequence combinations (n = 10) was 0.68 (95% confidence interval [CI]: 0.55, 0.82). ICC according to field strength was 0.78 (95% CI: 0.67, 0.88) at 1.5 T (n = 5) and 0.64 (95% CI: 0.49, 0.78) at 3.0 T (n = 5). ICCs according to vendor were 0.83 (95% CI: 0.73, 0.91) (n = 4) and 0.65 (95% CI: 0.51, 0.79) (n = 6). Average patient level variance was 0.042 kPa, with a coefficient of variation of 10.7%. Conclusion MR elastography is a reliable method for assessing liver stiffness, with small amounts of variability between imager manufacturers, field strengths, and pulse sequences. © RSNA, 2016.
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Affiliation(s)
- Andrew T Trout
- From the Department of Radiology (A.T.T., S.S., A.D.M., J.R.D.) and Department of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026; Philips Healthcare, Cincinnati, Ohio (H.W.); and Department of Mathematical Science, University of Cincinnati, Cincinnati, Ohio (Y.Z.)
| | - Suraj Serai
- From the Department of Radiology (A.T.T., S.S., A.D.M., J.R.D.) and Department of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026; Philips Healthcare, Cincinnati, Ohio (H.W.); and Department of Mathematical Science, University of Cincinnati, Cincinnati, Ohio (Y.Z.)
| | - Alana D Mahley
- From the Department of Radiology (A.T.T., S.S., A.D.M., J.R.D.) and Department of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026; Philips Healthcare, Cincinnati, Ohio (H.W.); and Department of Mathematical Science, University of Cincinnati, Cincinnati, Ohio (Y.Z.)
| | - Hui Wang
- From the Department of Radiology (A.T.T., S.S., A.D.M., J.R.D.) and Department of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026; Philips Healthcare, Cincinnati, Ohio (H.W.); and Department of Mathematical Science, University of Cincinnati, Cincinnati, Ohio (Y.Z.)
| | - Yue Zhang
- From the Department of Radiology (A.T.T., S.S., A.D.M., J.R.D.) and Department of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026; Philips Healthcare, Cincinnati, Ohio (H.W.); and Department of Mathematical Science, University of Cincinnati, Cincinnati, Ohio (Y.Z.)
| | - Bin Zhang
- From the Department of Radiology (A.T.T., S.S., A.D.M., J.R.D.) and Department of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026; Philips Healthcare, Cincinnati, Ohio (H.W.); and Department of Mathematical Science, University of Cincinnati, Cincinnati, Ohio (Y.Z.)
| | - Jonathan R Dillman
- From the Department of Radiology (A.T.T., S.S., A.D.M., J.R.D.) and Department of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026; Philips Healthcare, Cincinnati, Ohio (H.W.); and Department of Mathematical Science, University of Cincinnati, Cincinnati, Ohio (Y.Z.)
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19
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Magnetic Resonance Elastography for the Evaluation of Liver Fibrosis in Chronic Hepatitis B and C by Using Both Gradient-Recalled Echo and Spin-Echo Echo Planar Imaging: A Prospective Study. Am J Gastroenterol 2016; 111:823-33. [PMID: 26977760 DOI: 10.1038/ajg.2016.56] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 01/02/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Magnetic resonance elastography (MRE) with three-dimensional spin-echo echo planar imaging (3D-SE-EPI) is a newly emerging noninvasive method for assessing liver fibrosis. We hypothesized that 3D-SE-EPI might have better diagnostic accuracy than conventional two-dimensional gradient-recalled echo (2D-GRE). METHODS We prospectively included 179 consecutive patients with chronic hepatitis B (CHB) or C (CHC) who underwent both MRE and liver biopsy. Liver stiffness was measured by both 3D-SE-EPI and 2D-GRE for staging biopsy-proven liver fibrosis (using METAVIR scores). A receiver-operating characteristic analysis using the area under the receiver-operating characteristic curve (AUC) was used to compare the diagnostic performance in predicting liver fibrosis between these two techniques, and compared them to serum markers of fibrosis. RESULTS The technical failure rate of 3D-SE-EPI (2.2%, n=4/179) was lower compared with 2D-GRE (8.3%, n=15/179). The stiffness measured by 3D-SE-EPI was slightly lower compared with 2D-GRE, with the mean difference of 0.57 kPa (Bland and Altman plot, 95% limits of agreement: -0.32 and 1.45 kPa). AUCs for the characterization of ≥F1, ≥F2, ≥F3, and F4 were 0.957 (95% confidence interval (CI): 0.913-0.983), 0.971 (0.932-0.991), 0.991 (0.961-0.999), and 0.979 (0.942-0.995) for 3D-SE-EPI, which was slightly higher compared with the AUCs for 2D-GRE at each fibrosis stage (0.948 (0.901-0.977), 0.959 (0.915-0.981), 0.979 (0.943-0.995), and 0.976 (0.938-0.994), respectively), although none reached statistical significance (P=0.160-0.585). In an "intention-to-diagnose" analysis, the diagnostic accuracy (the proportion of well-classified patients) by EPI (86.7-91.3%, n=169) was higher compared with GRE (80.9-82.1%, n=158) after applying optimal cutoffs. Both 3D-SE-EPI and 2D-GRE performed better than serum fibrosis markers. CONCLUSIONS With respect to 2D-GRE, 3D-SE-EPI has the advantage of lower failure rate with equivalent high diagnostic performance for staging liver fibrosis in CHB/CHC patients, and thus more helpful for those challenging cases in 2D-GRE.
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20
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Saito S, Tanaka K, Hashido T. Magnetic Resonance Elastography: Measurement of Hepatic Stiffness Using Different Direct Inverse Problem Reconstruction Methods in Healthy Volunteers and Patients with Liver Disease. Nihon Hoshasen Gijutsu Gakkai Zasshi 2016; 72:128-38. [PMID: 26902377 DOI: 10.6009/jjrt.2016_jsrt_72.2.128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this study was to compare the mean hepatic stiffness values obtained by the application of two different direct inverse problem reconstruction methods to magnetic resonance elastography (MRE). Thirteen healthy men (23.2±2.1 years) and 16 patients with liver diseases (78.9±4.3 years; 12 men and 4 women) were examined for this study using a 3.0 T-MRI. The healthy volunteers underwent three consecutive scans, two 70-Hz waveform and a 50-Hz waveform scans. On the other hand, the patients with liver disease underwent scanning using the 70-Hz waveform only. The MRE data for each subject was processed twice for calculation of the mean hepatic stiffness (Pa), once using the multiscale direct inversion (MSDI) and once using the multimodel direct inversion (MMDI). There were no significant differences in the mean stiffness values among the scans obtained with two 70-Hz and different waveforms. However, the mean stiffness values obtained with the MSDI technique (with mask: 2895.3±255.8 Pa, without mask: 2940.6±265.4 Pa) were larger than those obtained with the MMDI technique (with mask: 2614.0±242.1 Pa, without mask: 2699.2±273.5 Pa). The reproducibility of measurements obtained using the two techniques was high for both the healthy volunteers [intraclass correlation coefficients (ICCs): 0.840-0.953] and the patients (ICC: 0.830-0.995). These results suggest that knowledge of the characteristics of different direct inversion algorithms is important for longitudinal liver stiffness assessments such as the comparison of different scanners and evaluation of the response to fibrosis therapy.
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Affiliation(s)
- Shigeyoshi Saito
- Department of Medical Physics and Engineering, Division of Health Sciences, Osaka University, Graduate School of Medicine
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21
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Low G, Kruse SA, Lomas DJ. General review of magnetic resonance elastography. World J Radiol 2016; 8:59-72. [PMID: 26834944 PMCID: PMC4731349 DOI: 10.4329/wjr.v8.i1.59] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/14/2015] [Accepted: 12/04/2015] [Indexed: 02/06/2023] Open
Abstract
Magnetic resonance elastography (MRE) is an innovative imaging technique for the non-invasive quantification of the biomechanical properties of soft tissues via the direct visualization of propagating shear waves in vivo using a modified phase-contrast magnetic resonance imaging (MRI) sequence. Fundamentally, MRE employs the same physical property that physicians utilize when performing manual palpation - that healthy and diseased tissues can be differentiated on the basis of widely differing mechanical stiffness. By performing “virtual palpation”, MRE is able to provide information that is beyond the capabilities of conventional morphologic imaging modalities. In an era of increasing adoption of multi-parametric imaging approaches for solving complex problems, MRE can be seamlessly incorporated into a standard MRI examination to provide a rapid, reliable and comprehensive imaging evaluation at a single patient appointment. Originally described by the Mayo Clinic in 1995, the technique represents the most accurate non-invasive method for the detection and staging of liver fibrosis and is currently performed in more than 100 centers worldwide. In this general review, the mechanical properties of soft tissues, principles of MRE, clinical applications of MRE in the liver and beyond, and limitations and future directions of this discipline -are discussed. Selected diagrams and images are provided for illustration.
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22
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Rusak G, Zawada E, Lemanowicz A, Serafin Z. Whole-organ and segmental stiffness measured with liver magnetic resonance elastography in healthy adults: significance of the region of interest. ACTA ACUST UNITED AC 2015; 40:776-82. [PMID: 25331569 PMCID: PMC4372679 DOI: 10.1007/s00261-014-0278-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE MR elastography (MRE) is a recent non-invasive technique that provides in vivo data on the viscoelasticity of the liver. Since the method is not well established, several different protocols were proposed that differ in results. The aim of the study was to analyze the variability of stiffness measurements in different regions of the liver. METHODS Twenty healthy adults aged 24-45 years were recruited. The examination was performed using a mechanical excitation of 64 Hz. MRE images were fused with axial T2WI breath-hold images (thickness 10 mm, spacing 10 mm). Stiffness was measured as a mean value of each cross section of the whole liver, on a single largest cross section, in the right lobe, and in ROIs (50 pix.) placed in the center of the left lobe, segments 5/6, 7, 8, and the parahilar region. RESULTS Whole-liver stiffness ranged from 1.56 to 2.75 kPa. Mean segmental stiffness differed significantly between the tested regions (range from 1.55 ± 0.28 to 2.37 ± 0.32 kPa; P < 0.0001, ANOVA). Within-method variability of measurements ranged from 14 % for whole liver and segment 8-26 % for segment 7. Within-subject variability ranged from 13 to 31 %. Results of measurement within segment 8 were closest to the whole-liver method (ICC, 0.84). CONCLUSIONS Stiffness of the liver presented significant variability depending on the region of measurement. The most reproducible method is averaging of cross sections of the whole liver. There was significant variability between stiffness in subjects considered healthy, which requires further investigation.
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Affiliation(s)
- Grażyna Rusak
- Department of Radiology and Diagnostic Imaging, Nicolaus Copernicus University, Collegium Medicum, ul. Skłodowskiej-Curie 9, 85-094, Bydgoszcz, Poland
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Fenstad ER, Dzyubak B, Oh JK, Williamson EE, F Glockner J, Young PM, Anavekar NS, Leise MD, Ehman RL, Araoz PA, Venkatesh SK. Evaluation of liver stiffness with magnetic resonance elastography in patients with constrictive pericarditis: Preliminary findings. J Magn Reson Imaging 2015; 44:81-8. [PMID: 26691749 DOI: 10.1002/jmri.25126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 12/01/2015] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To evaluate with magnetic resonance elastography (MRE) whether patients with constrictive pericarditis (CP) have increased hepatic stiffness. CP results in reduced pericardial compliance, ventricular interdependence, and right heart failure. Patients with untreated CP may develop liver fibrosis and ultimately cirrhosis due to chronic venous congestion. Chronic venous congestion ± fibrosis may lead to increased liver stiffness. MATERIALS AND METHODS Prospectively, patients with suspected CP underwent 2D transthoracic echocardiography, cardiac MRI, and liver MRE. An automated method was used to draw regions of interest (ROIs) on the stiffness maps to calculate the mean liver stiffness in kilopascals (kPa). A t-test with α = 0.05 was performed between stiffness values of patients with positive and negative CP findings based on previously published echocardiography criteria. RESULTS Nineteen patients met inclusion criteria with a mean ± standard deviation (SD) age of 51 ± 16 years. Nine patients (47%) had CP. Mean liver stiffness trended higher in patients with CP compared to those without CP (4.04 kPa vs. 2.46; P = 0.045). Liver stiffness correlated with MRI septal bounce (P = 0.04), inferior vena cava size (P = 0.003), echo abnormal septal motion (P = 0.04), and echo mitral inflow variation >25% (P = 0.02). Only MRI septal bounce predicted CP by echocardiography (P < 0.001). CONCLUSION CP was associated with increased liver stiffness. The increased stiffness is most likely secondary to chronic hepatic venous congestion and/or fibrosis. MRE may be useful for noninvasive liver stiffness assessment in CP. J. Magn. Reson. Imaging 2016;44:81-88.
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Affiliation(s)
- Eric R Fenstad
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Bogdan Dzyubak
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jae K Oh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Phillip M Young
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nandan S Anavekar
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael D Leise
- Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard L Ehman
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Philip A Araoz
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Yasar TK, Wagner M, Bane O, Besa C, Babb JS, Kannengiesser S, Fung M, Ehman RL, Taouli B. Interplatform reproducibility of liver and spleen stiffness measured with MR elastography. J Magn Reson Imaging 2015; 43:1064-72. [PMID: 26469708 DOI: 10.1002/jmri.25077] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 09/29/2015] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To assess interplatform reproducibility of liver stiffness (LS) and spleen stiffness (SS) measured with magnetic resonance elastography (MRE) based on a 2D gradient echo (GRE) sequence. MATERIALS AND METHODS This prospective Health Insurance Portability and Accountability Act (HIPAA)-compliant and Institutional Review Board (IRB)-approved study involved 12 subjects (five healthy volunteers and seven patients with liver disease). A multislice 2D-GRE-based MRE sequence was performed using two systems from different vendors (3.0T GE and 1.5T Siemens) on the same day. Two independent observers measured LS and SS on confidence maps. Bland-Altman analysis (with coefficient of reproducibility, CR), coefficient of variability (CV), and intraclass correlation (ICC) were used to analyze interplatform, intra- and interobserver variability. Human data were validated using a gelatin-based phantom. RESULTS There was excellent reproducibility of phantom stiffness measurement (CV 4.4%). Mean LS values were 3.44-3.48 kPa and 3.62-3.63 kPa, and mean SS values were 7.54-7.91 kPa and 8.40-8.85 kPa at 3.0T and 1.5T for observers 1 and 2, respectively. The mean CVs between platforms were 9.2%-11.5% and 13.1%-14.4% for LS and SS, respectively, for observers 1 and 2. There was excellent interplatform reproducibility (ICC >0.88 and CR <36.2%) for both LS and SS, and excellent intra- and interobserver reproducibility (intraobserver: ICC >0.99, CV <2.1%, CR <6.6%; interobserver: ICC >0.97, CV and CR <16%). CONCLUSION This study demonstrates that 2D-GRE MRE provides platform- and observer-independent LS and SS measurements.
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Affiliation(s)
- Temel Kaya Yasar
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mathilde Wagner
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Octavia Bane
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Cecilia Besa
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - James S Babb
- Department of Radiology, New York University, New York, New York, USA
| | | | - Maggie Fung
- GE Healthcare, MR Applications & Workflow, New York, New York, USA
| | - Richard L Ehman
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bachir Taouli
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Zhang J, Arena C, Pednekar A, Lambert B, Dees D, Lee VV, Muthupillai R. Short-Term Repeatability of Magnetic Resonance Elastography at 3.0T: Effects of Motion-Encoding Gradient Direction, Slice Position, and Meal Ingestion. J Magn Reson Imaging 2015; 43:704-12. [PMID: 26331461 DOI: 10.1002/jmri.25035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 08/07/2015] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Magnetic resonance elastography (MRE) can estimate liver stiffness (LS) noninvasively. We prospectively assessed whether motion-encoding gradient (MEG) direction, slice position, or high-caloric food intake affects the repeatability of MRE measurements of LS. MATERIALS AND METHODS Twenty healthy volunteers (8 women, 12 men; age, 48 ± 12 years) were imaged in a 3.0T scanner at four timepoints: twice after overnight fasting (B1 , B2 ) and twice after consuming a 1050-calorie standardized meal (A1 , A2 ; after 30 and 60 min, respectively). Each session comprised sequential MRE acquisitions in which MEG was applied in three orthogonal directions with three slices positioned over the liver for each. Between sessions, the participants were repositioned to assess test-retest reproducibility. RESULTS The LS measurements before/after food intake were 3.36 ± 1.31 kPa/3.22 ± 1.03 kPa, 2.04 ± 0.33 kPa/2.27 ± 0.38 kPa, and 2.47 ± 0.50 kPa/2.64 ± 0.76 kPa for MEG superimposed along the anterior-posterior (AP), foot-head (FH), and right-left (RL) directions, respectively. Before and after food intake, LS estimates were lower and more reproducible (<10% coefficient of variation) when the MEG was in the FH direction, not the AP or RL direction. Liver stiffness estimates were significantly elevated after meal consumption when the MEG was in the FH direction (P < 0.05 for B1 vs. A1 , B1 vs. A2 , B2 vs. A1 , and B2 vs. A2 ). CONCLUSION MRE estimates of LS were highly reproducible, particularly when MEG was applied in the FH direction, suggesting that this method could be used for long-term monitoring of antifibrotic therapy without repeated biopsies. High-caloric food intake resulted in slightly elevated LS on MRE.
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Affiliation(s)
- Jiming Zhang
- Department of Diagnostic and Interventional Radiology, CHI St. Luke's Health, Houston, Texas, USA
| | - Claudio Arena
- Department of Diagnostic and Interventional Radiology, CHI St. Luke's Health, Houston, Texas, USA
| | - Amol Pednekar
- Department of Diagnostic and Interventional Radiology, CHI St. Luke's Health, Houston, Texas, USA.,Philips Healthcare, Highland Heights, Ohio, USA
| | - Brenda Lambert
- Department of Diagnostic and Interventional Radiology, CHI St. Luke's Health, Houston, Texas, USA
| | - Debra Dees
- Department of Diagnostic and Interventional Radiology, CHI St. Luke's Health, Houston, Texas, USA
| | | | - Raja Muthupillai
- Department of Diagnostic and Interventional Radiology, CHI St. Luke's Health, Houston, Texas, USA
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Yoshimitsu K, Mitsufuji T, Shinagawa Y, Fujimitsu R, Morita A, Urakawa H, Hayashi H, Takano K. MR elastography of the liver at 3.0 T in diagnosing liver fibrosis grades; preliminary clinical experience. Eur Radiol 2015; 26:656-63. [PMID: 26060066 DOI: 10.1007/s00330-015-3863-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 05/14/2015] [Accepted: 05/26/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To clarify the usefulness of 3.0-T MR elastography (MRE) in diagnosing the histological grades of liver fibrosis using preliminary clinical data. MATERIALS AND METHODS Between November 2012 and March 2014, MRE was applied to all patients who underwent liver MR study at a 3.0-T clinical unit. Among them, those who had pathological evaluation of liver tissue within 3 months from MR examinations were retrospectively recruited, and the liver stiffness measured by MRE was correlated with histological results. Institutional review board approved this study, waiving informed consent. RESULTS There were 70 patients who met the inclusion criteria. Liver stiffness showed significant correlation with the pathological grades of liver fibrosis (rho = 0.89, p < 0.0001, Spearman's rank correlation). Areas under the receiver operating characteristic curve were 0.93, 0.95, 0.99 and 0.95 for fibrosis score greater than or equal to F1, F2, F3 and F4, with cut-off values of 3.13, 3.85, 4.28 and 5.38 kPa, respectively. Multivariate analysis suggested that grades of necroinflammation also affected liver stiffness, but to a significantly lesser degree as compared to fibrosis. CONCLUSIONS 3.0-T clinical MRE was suggested to be sufficiently useful in assessing the grades of liver fibrosis. KEY POINTS MR elastography may help clinicians assess patients with chronic liver diseases. Usefulness of 3.0-T MR elastography has rarely been reported. Measured liver stiffness correlated well with the histological grades of liver fibrosis. Measured liver stiffness was also affected by necroinflammation, but to a lesser degree. 3.0-T MRE could be a non-invasive alternative to liver biopsy.
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Affiliation(s)
- Kengo Yoshimitsu
- Department of Radiology, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 801-1011, Japan.
| | - Toshimichi Mitsufuji
- Department of Radiology, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 801-1011, Japan
| | - Yoshinobu Shinagawa
- Department of Radiology, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 801-1011, Japan
| | - Ritsuko Fujimitsu
- Department of Radiology, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 801-1011, Japan
| | - Ayako Morita
- Department of Radiology, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 801-1011, Japan
| | - Hiroshi Urakawa
- Department of Radiology, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 801-1011, Japan
| | - Hiroyuki Hayashi
- Department of Pathology, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 801-1011, Japan
| | - Koichi Takano
- Department of Radiology, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 801-1011, Japan
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Ichikawa S, Motosugi U, Morisaka H, Sano K, Ichikawa T, Enomoto N, Matsuda M, Fujii H, Onishi H. Validity and Reliability of Magnetic Resonance Elastography for Staging Hepatic Fibrosis in Patients with Chronic Hepatitis B. Magn Reson Med Sci 2015; 14:211-21. [PMID: 25994038 DOI: 10.2463/mrms.2014-0150] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We evaluated the validity and reliability of magnetic resonance elastography (MRE) for staging hepatic fibrosis in patients with chronic hepatitis B. METHODS The study included 73 patients with chronic hepatitis B and confirmed stages of pathological fibrosis. Two radiologists measured liver stiffness using MRE in all cases. We compared the area under the receiver operating characteristic (ROC) curve (Az) for distinguishing stages of fibrosis compared with MRE liver stiffness measurements and serum fibrosis markers. We used intraclass correlation coefficients to analyze interobserver agreement for measurements of liver stiffness and 2 one-sided t-tests to test the equivalence of the measurements by the 2 observers. RESULTS ROC analyses revealed the significantly superior discrimination abilities of MRE for liver fibrosis staging (Az = 0.945 to 0.978 [Observer 1] and 0.936 to 0.967 [Observer 2]) to those of serum fibrosis markers (0.491 to 0.742) for both observers (P < 0.0004). The intraclass correlation coefficient between the 2 observers was excellent (ρ = 0.971), and the measurements of liver stiffness by the 2 observers were statistically equivalent within a 0.1-kPa difference (P = 0.0157)CONCLUSION: MRE is a valid and reliable technique for discriminating the stage of hepatic fibrosis in patients with chronic hepatitis B.
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