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Honarvar M, Lobo J, Schneider C, Wolfe N, Gawrieh S, Loomba R, Ramji A, Hassanein T, Yoshida EM, Pang E, Curry MP, Afdhal NH. Deep Learning Based Shear Wave Detection and Segmentation Tool for Use in Point-of-Care for Chronic Liver Disease Assessments. ULTRASOUND IN MEDICINE & BIOLOGY 2024:S0301-5629(24)00299-0. [PMID: 39244483 DOI: 10.1016/j.ultrasmedbio.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 09/09/2024]
Abstract
OBJECTIVE As metabolic dysfunction-associated steatotic liver disease (MASLD) becomes more prevalent worldwide, it is imperative to create more accurate technologies that make it easy to assess the liver in a point-of-care setting. The aim of this study is to test the performance of a new software tool implemented in Velacur (Sonic Incytes), a liver stiffness and ultrasound attenuation measurement device, on patients with MASLD. This tool employs a deep learning-based method to detect and segment shear waves in the liver tissue for subsequent analysis to improve tissue characterization for patient diagnosis. METHODS This new tool consists of a deep learning based algorithm, which was trained on 15,045 expert-segmented images from 103 patients, using a U-Net architecture. The algorithm was then tested on 4429 images from 36 volunteers and patients with MASLD. Test subjects were scanned at different clinics with different Velacur operators. Evaluation was performed on both individual images (image based) and averaged across all images collected from a patient (patient based). Ground truth was defined by expert segmentation of the shear waves within each image. For evaluation, sensitivity and specificity for correct wave detection in the image were calculated. For those images containing waves, the Dice coefficient was calculated. A prototype of the software tool was also implemented on Velacur and assessed by operators in real world settings. RESULTS The wave detection algorithm had a sensitivity of 81% and a specificity of 84%, with a Dice coefficient of 0.74 and 0.75 for image based and patient-based averages respectively. The implementation of this software tool as an overlay on the B-Mode ultrasound resulted in improved exam quality collected by operators. CONCLUSION The shear wave algorithm performed well on a test set of volunteers and patients with metabolic dysfunction-associated steatotic liver disease. The addition of this software tool, implemented on the Velacur system, improved the quality of the liver assessments performed in a real world, point of care setting.
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Affiliation(s)
| | - Julio Lobo
- Sonic Incytes Medical Corp., Vancouver, BC, Canada
| | | | | | - Samer Gawrieh
- Indiana University School of Medicine, Division of Gastroenterology and Hepatology, Indianapolis, IN, USA
| | - Rohit Loomba
- University of California San Diego, Division of Gastroenterology San Diego, CA, USA
| | - Alnoor Ramji
- University of British Columbia, Division of Gastroenterology, Vancouver, BC, Canada
| | | | - Eric M Yoshida
- University of British Columbia, Division of Gastroenterology, Vancouver, BC, Canada
| | - Emily Pang
- Vancouver General Hospital, Department of Radiology, Vancouver BC, Canada
| | - Michael P Curry
- Beth Israel Deaconess Medical Center, Division of Gastroenterology, Boston, MA, USA
| | - Nezam H Afdhal
- Beth Israel Deaconess Medical Center, Division of Gastroenterology, Boston, MA, USA
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Zhou L, Peng Q, Tang W, Wu N, Yang L, Qi L, Li J, Huang Y. Magnetic Resonance Elastography of Anterior Mediastinal Tumors. J Magn Reson Imaging 2024. [PMID: 38855820 DOI: 10.1002/jmri.29481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/27/2024] [Accepted: 04/30/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Preoperative differentiation of the types of mediastinal tumors is essential. Magnetic resonance (MR) elastography potentially provides a noninvasive method to assess the classification of mediastinal tumor subtypes. PURPOSE To evaluate the use of MR elastography in anterior mediastinal masses and to characterize the mechanical properties of tumors of different subtypes. STUDY TYPE Prospective. SUBJECTS 189 patients with anterior mediastinal tumors (AMTs) confirmed by histopathology (62 thymomas, 53 thymic carcinomas, 57 lymphomas, and 17 germ cell tumors). FIELD STRENGTH/SEQUENCE A gradient echo-based 2D MR elastography sequence and a diffusion-weighted imaging (DWI) sequence at 3.0 T. ASSESSMENT Stiffness and apparent diffusion coefficients (ADC) were measured in AMTs using MR elastography-derived elastograms and DWI-derived ADC maps, respectively. The aim of this study is to identify whether MR elastography can differentiate between the histological subtypes of ATMs. STATISTICAL TESTS One-way analysis of variance (ANOVA), two-way ANOVA, Pearson's linear correlation coefficient (r), receiver operating characteristic (ROC) curve analysis; P < 0.05 was considered significant. RESULTS Lymphomas had significantly lower stiffness than other AMTs (4.0 ± 0.63 kPa vs. 4.8 ± 1.39 kPa). The mean stiffness of thymic carcinomas was significantly higher than that of other AMTs (5.6 ± 1.41 kPa vs. 4.2 ± 0.94 kPa). Using a cutoff value of 5.0 kPa, ROC analysis showed that lymphomas could be differentiated from other AMTs with an accuracy of 59%, sensitivity of 97%, and specificity of 38%. Using a cutoff value of 5.1 kPa, thymic carcinomas could be differentiated from other AMTs with an accuracy of 84%, sensitivity of 67%, and specificity of 90%. However, there was an overlap in the stiffness values of individual thymomas (4.2 ± 0.71; 3.9-4.5), thymic carcinomas (5.6 ± 1.41; 5.0-6.1), lymphomas (4.0 ± 0.63; 3.8-4.2), and germ cell tumors (4.5 ± 1.79; 3.3-5.6). DATA CONCLUSION MR elastography-derived stiffness may be used to evaluate AMTs of various histologies. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Lina Zhou
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qin Peng
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wei Tang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Wu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Yang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Linlin Qi
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiang Li
- Office for Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yao Huang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Loomba R, Ramji A, Hassanein T, Yoshida EM, Pang E, Schneider C, Curry MP, Afdhal NH. Velacur ACE outperforms FibroScan CAP for diagnosis of MASLD. Hepatol Commun 2024; 8:e0402. [PMID: 38517204 PMCID: PMC10962894 DOI: 10.1097/hc9.0000000000000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/19/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND As the prevalence of metabolic dysfunction-associated steatotic liver disease increases, it is imperative to have noninvasive alternatives to liver biopsy. Velacur offers a non-invasive, point-of-care ultrasound-based method for the assessment of liver stiffness and attenuation. The aim of this study was to perform a head-to-head comparison of liver stiffness and liver fat determined by Velacur and FibroScan using MRI-based measurements as the reference standard. METHODS This prospective cross-sectional study included 164 adult participants with well-characterized metabolic dysfunction-associated steatotic liver disease. Patients underwent a research exam including Velacur, FibroScan and contemporaneous magnetic resonance elastography, and magnetic resonance imaging proton density fat fraction (MRI-PDFF) scans. The primary outcome was the presence of advanced fibrosis (>F2) as measured by magnetic resonance elastography and the presence of liver fat (>5%) as measured by MRI-PDFF. RESULTS The mean age and body mass index were 57±12 years and 30.6±4.8 kg/m2, respectively. The mean liver stiffness on magnetic resonance elastography was 3.22±1.39 kPa and the mean liver fat on MRI-PDFF was 14.2±8%. The liver stiffness assessments by Velacur and FibroScan were similar for the detection of advanced fibrosis (AUC 0.95 vs. 0.97) and were not statistically different (p=0.43). Velacur was significantly better than FibroScan (AUC 0.94 vs. 0.79, p=0.01), for the detection of MRI-PDFF >5% (diagnosis of metabolic dysfunction-associated liver disease). CONCLUSIONS Velacur was superior to FibroScan for liver fat detection with MRI-PDFF as the reference. Velacur and FibroScan were not statistically different for liver stiffness assessment as defined by magnetic resonance elastography.
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Affiliation(s)
- Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology, Department of Medicine
| | - Alnoor Ramji
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tarek Hassanein
- Southern California Research Center, Coronado, California, USA
| | - Eric M. Yoshida
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily Pang
- Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Michael P. Curry
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Nezam H. Afdhal
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Abstract
Early diagnosis of hepatic fibrosis (HF) is pivotal for management to cease progression to cirrhosis and hepatocellular carcinoma. HF is the telltale sign of chronic liver disease, and confirmed by liver biopsy, which is an invasive technique and inclined to sampling errors. The morphologic parameters of cirrhosis are assessed on conventional imaging such as on ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI). Newer imaging modalities such as magnetic resonance elastography and US elastography are reliable and accurate. More research studies on novel imaging modalities such as MRI with diffusion weighted imaging, enhancement by hepatobiliary contrast agents, and CT using perfusion are essential for earlier diagnosis, surveillance and accurate management. The purpose of this article is to discuss non-invasive CT, MRI, and US imaging modalities for diagnosis and stratify HF.
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Affiliation(s)
- Mayur Virarkar
- Department of Neuroradiology, The University of Texas Health Science Center, Houston, TX.
| | - Ajaykumar C Morani
- Department of Abdominal Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Melissa W Taggart
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Priya Bhosale
- Department of Abdominal Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Serag D, Ragab E. Diffusion-weighted MRI in staging of post hepatitis C fibrosis: does ADC value challenge liver biopsy? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00283-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
There is obvious interest in finding a non-invasive diagnostic tool to detect the development of hepatic fibrosis and distinguish between its various stages. Chronic inflammation of the liver secondary to viral hepatitis, autoimmune conditions, sclerosing cholangitis, drug toxicity, chronic alcohol intake, different metabolic disorders, and steatosis lead to fibrosis and maybe cirrhosis. The current study aimed to assess the usefulness of diffusion-weighted magnetic resonance imaging (DW-MRI) in diagnosis of post hepatitis C fibrosis and detection of its stage.
Results
A prospective study had included 232 participants; 120 patients had chronic hepatitis C with/without HCC and 112 subjects had normal liver. There was no significant difference between the two groups regarding age or gender (p 0.192 and 0.227 respectively). DW-MRI was performed using 1.5 T machine. The mean liver ADC values and normalized liver ADC (liver ADC/spleen ADC) were measured at b value 800 s/mm2; both were significantly lower among cases than controls. Cutoff values of liver ADC were 1.531 × 10−3 mm2/s, 1.409 × 10−3 mm2/s, 1.192 × 10−3 mm2/s, and 1.093 × 10−3 mm2/s for METAVIR stages ≥ F1, ≥ F2, ≥ F3, and F4, respectively. Normalized liver ADC showed larger area under the curve (AUC) than mean liver ADC in all differentiation categories except for differentiating between F0 and all other fibrosis stages.
Conclusion
In line with the literature, DW-MR imaging using b value of 800 s/mm2 has proved to be a valuable diagnostic technique for detection and staging of post hepatitis C fibrosis/cirrhosis being noninvasive procedure with acceptable accuracy. DWI using liver/spleen ADC values raised the diagnostic performance with AUC more than 90% in all fibrosis stages on METAVIR score.
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Zhou IY, Catalano OA, Caravan P. Advances in functional and molecular MRI technologies in chronic liver diseases. J Hepatol 2020; 73:1241-1254. [PMID: 32585160 PMCID: PMC7572718 DOI: 10.1016/j.jhep.2020.06.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 02/06/2023]
Abstract
MRI has emerged as the most comprehensive non-invasive diagnostic tool for liver diseases. In recent years, the value of MRI in hepatology has been significantly enhanced by a wide range of contrast agents, both clinically available and under development, that add functional information to anatomically detailed morphological images, or increase the distinction between normal and pathological tissues by targeting molecular and cellular events. Several classes of contrast agents are available for contrast-enhanced hepatic MRI, including i) conventional non-specific extracellular fluid contrast agents for assessing tissue perfusion; ii) hepatobiliary-specific contrast agents that are taken up by functioning hepatocytes and excreted through the biliary system for evaluating hepatobiliary function; iii) superparamagnetic iron oxide particles that accumulate in Kupffer cells; and iv) novel molecular contrast agents that are biochemically targeted to specific molecular/cellular processes for staging liver diseases or detecting treatment responses. The use of different functional and molecular MRI methods enables the non-invasive assessment of disease burden, progression, and treatment response in a variety of liver diseases. A high diagnostic performance can be achieved with MRI by combining imaging biomarkers.
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Affiliation(s)
- Iris Y. Zhou
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States.,Harvard Medical School, Boston, MA, USA,Institute for Innovation in Imaging (i3), Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Onofrio A. Catalano
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States.,Harvard Medical School, Boston, MA, USA,Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Peter Caravan
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States; Harvard Medical School, Boston, MA, USA; Institute for Innovation in Imaging (i(3)), Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.
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Cruz M, Ferreira AA, Papanikolaou N, Banerjee R, Alves FC. New boundaries of liver imaging: from morphology to function. Eur J Intern Med 2020; 79:12-22. [PMID: 32571581 DOI: 10.1016/j.ejim.2020.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/20/2020] [Accepted: 06/04/2020] [Indexed: 12/12/2022]
Abstract
From an invisible organ to one of the most explored non-invasively, the liver is, today, one of the cornerstones for current cross-sectional imaging techniques and minimally invasive procedures. After the achievements of US, CT and, most recently, MRI in providing highly accurate morphological and structural information about the organ, a significant scientific development has gained momentum for the last decades, coupling morphology to liver function and contributing far most to what we know today as precision medicine. In fact, dedicated tailor-made investigations are now possible in order to detect and, most of all, quantify physiopathological processes with unprecedented certitude. It is the intention of this review to provide a better insight to the reader of several functional imaging techniques applied to liver imaging. Contrast enhanced imaging, diffusion weighted imaging, elastography, spectral computed tomography and fat and iron assessment techniques are commonly performed clinically. Diffusion kurtosis imaging, magnetic resonance spectroscopy, T1 relaxometry and radiomics remain largely limited to advanced clinical research. Each of them has its own value and place on the diagnostic armamentarium and provide unique qualitative and quantitative information regarding the pathophysiology of diseases, contributing at a large scale to model therapeutic decisions and patient follow-up. Therefore, state-of-the-art liver imaging acts today as a non-invasive surrogate biomarker of many focal and diffuse liver diseases.
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Affiliation(s)
- Manuel Cruz
- Department of Radiology, Faculty of Medicine, University Hospital Coimbra and CIBIT/ICNAS research center, University of Coimbra, Coimbra, Portugal.
| | - Ana Aguiar Ferreira
- Department of Radiology, Faculty of Medicine, University Hospital Coimbra and CIBIT/ICNAS research center, University of Coimbra, Coimbra, Portugal
| | - Nikolaos Papanikolaou
- Computational Clinical Imaging Group, Centre for the Unknown, Champalimaud Foundation, Lisbon, Portugal
| | - Rajarshi Banerjee
- Department of Acute Medicine, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Filipe Caseiro Alves
- Department of Radiology, Faculty of Medicine, University Hospital Coimbra and CIBIT/ICNAS research center, University of Coimbra, Coimbra, Portugal
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Forsgren MF, Nasr P, Karlsson M, Dahlström N, Norén B, Ignatova S, Sinkus R, Cedersund G, Leinhard OD, Ekstedt M, Kechagias S, Lundberg P. Biomarkers of liver fibrosis: prospective comparison of multimodal magnetic resonance, serum algorithms and transient elastography. Scand J Gastroenterol 2020; 55:848-859. [PMID: 32684060 DOI: 10.1080/00365521.2020.1786599] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Accurate biomarkers for quantifying liver fibrosis are important for clinical practice and trial end-points. We compared the diagnostic performance of magnetic resonance imaging (MRI), including gadoxetate-enhanced MRI and 31P-MR spectroscopy, with fibrosis stage and serum fibrosis algorithms in a clinical setting. Also, in a subset of patients, MR- and transient elastography (MRE and TE) was evaluated when available. METHODS Patients were recruited prospectively if they were scheduled to undergo liver biopsy on a clinical indication due to elevated liver enzyme levels without decompensated cirrhosis. Within a month of the clinical work-up, an MR-examination and liver needle biopsy were performed on the same day. Based on late-phase gadoxetate-enhanced MRI, a mathematical model calculated hepatobiliary function (relating to OATP1 and MRP2). The hepatocyte gadoxetate uptake rate (KHep) and the normalised liver-to-spleen contrast ratio (LSC_N10) were also calculated. Nine serum fibrosis algorithms were investigated (GUCI, King's Score, APRI, FIB-4, Lok-Index, NIKEI, NASH-CRN regression score, Forns' score, and NAFLD-fibrosis score). RESULTS The diagnostic performance (AUROC) for identification of significant fibrosis (F2-4) was 0.78, 0.80, 0.69, and 0.78 for MRE, TE, LSC_N10, and GUCI, respectively. For the identification of advanced fibrosis (F3-4), the AUROCs were 0.93, 0.84, 0.81, and 0.82 respectively. CONCLUSION MRE and TE were superior for non-invasive identification of significant fibrosis. Serum fibrosis algorithms developed for specific liver diseases are applicable in this cohort of diverse liver diseases aetiologies. Gadoxetate-MRI was sufficiently sensitive to detect the low function losses associated with fibrosis. None was able to efficiently distinguish between stages within the low fibrosis stages.Lay summaryExcessive accumulation of scar tissue, fibrosis, in the liver is an important aspect in chronic liver disease. To replace the invasive needle biopsy, we have explored non-invasive methods to assess liver fibrosis. In our study we found that elastographic methods, which assess the mechanical properties of the liver, are superior in assessing fibrosis in a clinical setting. Of interest from a clinical trial point-of-view, none of the tested methods was sufficiently accurate to distinguish between adjacent moderate fibrosis stages.
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Affiliation(s)
- Mikael F Forsgren
- Department of Radiation Physics, Department of and Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Patrik Nasr
- Department of Gastroenterology and Hepatology, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Markus Karlsson
- Department of Radiation Physics, Department of and Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Nils Dahlström
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Radiology, Department of and Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Bengt Norén
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Radiology, Department of and Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Simone Ignatova
- Department of Clinical Pathology and Clinical Genetics, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ralph Sinkus
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Gunnar Cedersund
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Olof Dahlqvist Leinhard
- Department of Radiation Physics, Department of and Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Mattias Ekstedt
- Department of Gastroenterology and Hepatology, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Stergios Kechagias
- Department of Gastroenterology and Hepatology, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Peter Lundberg
- Department of Radiation Physics, Department of and Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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Plaikner M, Kremser C, Zoller H, Steurer M, Glodny B, Jaschke W, Henninger B. Does gadoxetate disodium affect MRE measurements in the delayed hepatobiliary phase? Eur Radiol 2019; 29:829-837. [PMID: 30027410 PMCID: PMC6302879 DOI: 10.1007/s00330-018-5616-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/24/2018] [Accepted: 06/18/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To assess if the administration of gadoxetate disodium (Gd-EOB-DTPA) significantly affects hepatic magnetic resonance elastography (MRE) measurements in the delayed hepatobiliary phase (DHBP). METHODS A total of 47 patients (15 females, 32 males; age range 23-78 years, mean 54.28 years) were assigned to standard hepatic magnetic resonance imaging (MRI) with application of Gd-EOB-DTPA and hepatic MRE. MRE was performed before injection of Gd-EOB-DTPA and after 40-50 min in the DHBP. Liver stiffness values were obtained before and after contrast media application and differences between pre- and post-Gd-EOB-DTPA values were evaluated using a Bland-Altman plot and the Mann-Whitney-Wilcoxon test. In addition, the data were compared with regard to the resulting fibrosis classification. RESULTS Mean hepatic stiffness for pre-Gd-EOB-DTPA measurements was 4.01 kPa and post-Gd-EOB-DTPA measurements yielded 3.95 kPa. We found a highly significant individual correlation between pre- and post-Gd-EOB-DTPA stiffness values (Pearson correlation coefficient of r = 0.95 (p < 0.001) with no significant difference between the two measurements (p =0.49)). Bland-Altman plot did not show a systematic effect for the difference between pre- and post-stiffness measurements (mean difference: 0.06 kPa, SD 0.81). Regarding the classification of fibrosis stages, the overall agreement was 87.23% and the intraclass correlation coefficient was 96.4%, indicating excellent agreement. CONCLUSIONS Administration of Gd-EOB-DTPA does not significantly influence MRE stiffness measurements of the liver in the DHBP. Therefore, MRE can be performed in the DHBP. KEY POINTS • MRE of the liver can reliably be performed in the delayed hepatobiliary phase. • Gd-EOB-DTPA does not significantly influence MRE stiffness measurements of the liver. • MRE performed in the delayed hepatobiliary-phase is reasonable in patients with reduced liver function.
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Affiliation(s)
- M Plaikner
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - C Kremser
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - H Zoller
- Department of Internal Medicine, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - M Steurer
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - B Glodny
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - W Jaschke
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - B Henninger
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria.
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New and Emerging Applications of Magnetic Resonance Elastography of Other Abdominal Organs. Top Magn Reson Imaging 2019; 27:335-352. [PMID: 30289829 DOI: 10.1097/rmr.0000000000000182] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Increasing clinical experience and ongoing research in the field of magnetic resonance elastography (MRE) is leading to exploration of its applications in other abdominal organs. In this review, the current research progress of MRE in prostate, uterus, pancreas, spleen, and kidney will be discussed. The article will describe patient preparation, modified technical approach including development of passive drivers, modification of sequences, and inversion. The potential clinical application of MRE in the evaluation of several disease processes affecting these organs will be discussed. In an era of increasing adoption of multiparametric magnetic resonance imaging approaches for solving complex abdominal problems, abdominal MRE as a biomarker may be seamlessly incorporated into a standard magnetic resonance imaging examination to provide a rapid, reliable, and comprehensive imaging evaluation at a single patient appointment in the future.
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Jondal DE, Wang J, Chen J, Gorny KR, Felmlee J, Hesly G, Laughlin-Tommaso S, Stewart EA, Ehman R, Woodrum DA. Uterine fibroids: correlations between MRI appearance and stiffness via magnetic resonance elastography. Abdom Radiol (NY) 2018; 43:1456-1463. [PMID: 28952003 DOI: 10.1007/s00261-017-1314-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
RATIONALE AND OBJECTIVES Magnetic resonance elastography has proven to be a valuable tool in the diagnosis of liver fibrosis, breast and cervical cancer, but its application in uterine fibroids requires further characterization. The aim of the present study was to examine the relationship between uterine fibroid stiffness by MRE and MR imaging characteristics. MATERIALS AND METHODS An IRB-approved, HIPAA compliant review was performed of prospectively collected pelvic MRI and 2D-MRE data in patients with symptomatic uterine fibroids (N = 102). T1 and T2 weighted pelvic MRI with gadolinium enhancement were performed. In a small patient subset, fibroid stiffness was assessed by both 2D and 3D MRE. Fibroid stiffness by modality or imaging characteristics was analyzed using one-way analysis of variance followed by Student t test. RESULTS Four fibroid groups were identified based on T2 appearance: Isointense (N = 7), bright (N = 6), dark with minimal heterogeneity (N = 69), and dark with substantial heterogeneity (N = 20). Mean fibroid stiffness was 4.81 ± 2.12 kPa. Comparison of fibroid stiffness by T2 signal intensity showed that T2 bright fibroids were significantly less stiff than fibroids appearing T2 dark with minimal heterogeneity (mean stiffness difference = 2.38 kPa; p < 0.05) and T2 dark fibroids with substantial heterogeneity were significantly less stiff than T2 dark fibroids with minimal heterogeneity (mean difference = 1.25 kPa; p < 0.05). There was no significant association between fibroid stiffness and T1 signal characteristics or gadolinium enhancement. There was no significant difference in stiffness values obtained by either 2D vs. 3D MRE. CONCLUSIONS These data suggest differences in fibroid stiffness are associated with different T2 imaging characteristics with less stiff fibroids being T2 bright and more stiff fibroids being T2 dark. Further studies are needed to determine if fibroid stiffness by MRE may serve as an imaging biomarker to help predict MR-guided treatment response.
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Affiliation(s)
- Danielle E Jondal
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jin Wang
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jun Chen
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Krzysztof R Gorny
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Joel Felmlee
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Gina Hesly
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Shannon Laughlin-Tommaso
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Elizabeth A Stewart
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Richard Ehman
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - David A Woodrum
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Lee DH, Lee JM, Yoon JH, Kim YJ, Lee JH, Yu SJ, Han JK. Liver Stiffness Measured by Two-Dimensional Shear-Wave Elastography: Prognostic Value after Radiofrequency Ablation for Hepatocellular Carcinoma. Liver Cancer 2018; 7:65-75. [PMID: 29662834 PMCID: PMC5892360 DOI: 10.1159/000484445] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To evaluate the prognostic value of liver stiffness (LS) measured using two-dimensional (2D) shear-wave elastography (SWE) in patients with hepatocellular carcinoma (HCC) treated by radiofrequency ablation (RFA). METHODS The Institutional Review Board approved this retrospective study and informed consent was obtained from all patients. A total of 134 patients with up to 3 HCCs ≤5 cm who had undergone pre-procedural 2D-SWE prior to RFA treatment between January 2012 and December 2013 were enrolled. LS values were measured using real-time 2D-SWE before RFA on the procedural day. After a mean follow-up of 33.8 ± 9.9 months, we analyzed the overall survival after RFA using the Kaplan-Meier method and Cox proportional hazard regression model. The optimal cutoff LS value to predict overall survival was determined using the minimal p value approach. RESULTS During the follow-up period, 22 patients died, and the estimated 1- and 3-year overall survival rates were 96.4 and 85.8%, respectively. LS measured by 2D-SWE was found to be a significant predictive factor for overall survival after RFA of HCCs, as was the presence of extrahepatic metastases. As for the optimal cutoff LS value for the prediction of overall survival, it was determined to be 13.3 kPa. In our study, 71 patients had LS values ≥13.3 kPa, and the estimated 3-year overall survival was 76.8% compared to 96.3% in 63 patients with LS values <13.3 kPa. This difference was statistically significant (hazard ratio = 4.30 [1.26-14.7]; p = 0.020). CONCLUSION LS values measured by 2D-SWE was a significant predictive factor for overall survival after RFA for HCC.
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Affiliation(s)
- Dong Ho Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea,Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea,*Jeong Min Lee, MD, Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744 (Korea), E-Mail
| | - Jung-Hwan Yoon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yoon Jun Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Su Jong Yu
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea,Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
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13
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Prognostic Role of Liver Stiffness Measurements Using Magnetic Resonance Elastography in Patients with Compensated Chronic Liver Disease. Eur Radiol 2018; 28:3513-3521. [PMID: 29488082 DOI: 10.1007/s00330-017-5278-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/13/2017] [Accepted: 12/21/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE To retrospectively evaluate the prognostic role of liver stiffness (LS) measurement using magnetic resonance elastography (MRE) in patients with compensated chronic liver disease (cCLD). METHODS We enrolled 217 patients with cCLD who underwent MRE. After mean follow-up of 45.0 ± 17.6 months, cumulative incidence (CI) of hepatocellular carcinoma (HCC) occurrence, development of decompensation and overall survival (OS) were estimated using the Kaplan-Meier method. Prognostic factors were evaluated using the Cox proportional hazard regression model. RESULTS During the follow-up period, HCC occurred in 33 patients, and 1-, 3- and 5-year CIs of HCC occurrence were 3.8%, 14.8% and 18.9%, respectively. The LS value was a significant predictive factor for HCC occurrence [p < 0.001, hazard ratio (HR) = 1.59 per unit (1.25-2.03)]. Eighteen patients experienced hepatic decompensation, and 1-, 3- and 5-year CIs of decompensation were 2.8%, 7.3% and 11.3%, respectively. The LS value was also significantly associated with decompensation development [p < 0.001, HR = 2.02 per unit (1.37-2.98)]. Fourteen patients died, and 1-, 3- and 5-year OSs were 99.1%, 98.0% and 89.8%, respectively. The LS value was demonstrated to be a significant affecting factor for OS [p = 0.008, HR = 1.39 per unit (1.10-1.78)]. CONCLUSIONS LS obtained from MRE was a significant predictive factor for the development of decompensation, HCC occurrence and OS in cCLD patients. KEY POINTS • Liver stiffness (LS) values obtained from MRE can provide prognostic information. • The LS value was a significant predictive factor for occurrence of hepatocellular carcinoma. • The LS value was significantly associated with development of hepatic decompensation. • Survival of compensated chronic liver disease patients was affected by the LS value.
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14
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Imaging biomarkers in liver fibrosis. RADIOLOGIA 2017; 60:74-84. [PMID: 29108657 DOI: 10.1016/j.rx.2017.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 08/29/2017] [Accepted: 09/03/2017] [Indexed: 02/07/2023]
Abstract
There is a need for early identification of patients with chronic liver diseases due to their increasing prevalence and morbidity-mortality. The degree of liver fibrosis determines the prognosis and therapeutic options in this population. Liver biopsy represents the reference standard for fibrosis staging. However, given its limitations and complications, different non-invasive methods have been developed recently for the in vivo quantification of fibrosis. Due to their precision and reliability, biomarkers' measurements derived from Ultrasound and Magnetic Resonance stand out. This article reviews the different acquisition techniques and image processing methods currently used in the evaluation of liver fibrosis, focusing on their diagnostic performance, applicability and clinical value. In order to properly interpret their results in the appropriate clinical context, it seems necessary to understand the techniques and their quality parameters, the standardization and validation of the measurement units and the quality control of the methodological problems.
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15
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Joshi M, Dillman JR, Towbin AJ, Serai SD, Trout AT. MR elastography: high rate of technical success in pediatric and young adult patients. Pediatr Radiol 2017; 47:838-843. [PMID: 28367603 DOI: 10.1007/s00247-017-3831-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/25/2017] [Accepted: 03/06/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Magnetic resonance (MR) elastography allows the noninvasive assessment of liver stiffness, which is a surrogate for fibrosis. OBJECTIVE The purpose of this study was to describe our experience using liver MR elastography in a large pediatric population with attention to the frequency and causes of exam failure. MATERIALS AND METHODS Imaging records were searched for patients ≤18 years of age who underwent 2-D gradient recalled echo (GRE) MR elastography of the liver between September 2011 and August 2015 on one of two 1.5-T MRI platforms. Imaging reports and clinical records were reviewed for failed MR elastography acquisitions, factor(s) resulting in failure and whether a subsequent successful examination had been performed. RESULTS Four hundred sixty-eight MR elastography examinations were performed in 372 patients between 1.5 months and 18 years of age during the study period. Ninety-six percent (450/468) of the examinations were successful. There was no significant difference in mean age (12.6±3.6 vs. 11.2±4.1 years, P=0.12) or body mass index (BMI) (28.2±12.4 vs. 29.5±10 kg/m2, P=0.6) between patients with and without successful examinations. MR elastography failures were due to poor paddle positioning resulting in inadequate generation of hepatic shear waves (n=5), iron overload (n=4), patient inability to tolerate MRI (n=3), patient breathing/motion (n=3), artifact from implanted hardware (n=1) and technical malfunction (n=2). Seven of nine (78%) repeat examinations were successful (78%). CONCLUSION Hepatic 2-D GRE MR elastography at 1.5 T is technically robust in children. Exam failure is infrequent and largely reflects patient specific factors, some of which can be mitigated with careful technique.
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Affiliation(s)
- Madalsa Joshi
- Department of Radiology, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Jonathan R Dillman
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229-3026, USA
| | - Alexander J Towbin
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229-3026, USA
| | - Suraj D Serai
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229-3026, USA
| | - Andrew T Trout
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229-3026, USA.
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16
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Donato H, França M, Candelária I, Caseiro-Alves F. Liver MRI: From basic protocol to advanced techniques. Eur J Radiol 2017; 93:30-39. [PMID: 28668428 DOI: 10.1016/j.ejrad.2017.05.028] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/18/2017] [Accepted: 05/22/2017] [Indexed: 02/07/2023]
Abstract
Liver MR is a well-established modality with multiparametric capabilities. However, to take advantage of its full capacity, it is mandatory to master the technique and optimize imaging protocols, apply advanced imaging concepts and understand the use of different contrast media. Physiologic artefacts although inherent to upper abdominal studies can be minimized using triggering techniques and new strategies for motion control. For standardization, the liver MR protocol should include motion-resistant T2-w sequences, in-op phase GRE T1 and T2-w fast spin echo sequences with fat suppression. Diffusion-weighted imaging (DWI) is mandatory, especially for detection of sub-centimetre metastases. Contrast-enhanced MR is the cornerstone of liver MR, especially for lesion characterization. Although extracellular agents are the most extensively used contrast agents, hepatobiliary contrast media can provide an extra-layer of functional diagnostic information adding to the diagnostic value of liver MR. The use of high field strength (3T) increases SNR but is more challenging especially concerning artefact control. Quantitative MR belongs to the new and evolving field of radiomics where the use of emerging biomarkers such as perfusion or DWI can derive new information regarding disease detection, prognostication and evaluation of tumour response. This information can overcome some of the limitations of current tests, especially when using vascular disruptive agents for oncologic treatment assessment. MR is, today, a robust, mature, multiparametric imaging modality where clinical applications have greatly expanded from morphology to advanced imaging. This new concept should be acknowledged by all those involved in producing high quality, high-end liver MR studies.
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Affiliation(s)
- Henrique Donato
- Imaging Department, Faculty of Medicine of Coimbra, University Centre Hospitals of Coimbra (CHUC), Portugal.
| | - Manuela França
- Imaging Department, Centro Hospitalar do Porto, Portugal.
| | - Isabel Candelária
- Imaging Department, Faculty of Medicine of Coimbra, University Centre Hospitals of Coimbra (CHUC), Portugal.
| | - Filipe Caseiro-Alves
- Imaging Department, Faculty of Medicine of Coimbra, University Centre Hospitals of Coimbra (CHUC), Portugal.
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17
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Procopet B, Berzigotti A. Diagnosis of cirrhosis and portal hypertension: imaging, non-invasive markers of fibrosis and liver biopsy. Gastroenterol Rep (Oxf) 2017; 5:79-89. [PMID: 28533906 PMCID: PMC5421457 DOI: 10.1093/gastro/gox012] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 03/15/2017] [Indexed: 12/12/2022] Open
Abstract
The concept of ‘cirrhosis’ is evolving and it is now clear that compensated and decompensated cirrhosis are completely different in terms of prognosis. Furthermore, the term ‘advanced chronic liver disease (ACLD)’ better reflects the continuum of histological changes occurring in the liver, which continue to progress even after cirrhosis has developed, and might regress after removing the etiological factor causing the liver disease. In compensated ACLD, portal hypertension marks the progression to a stage with higher risk of clinical complication and requires an appropriate evaluation and treatment. Invasive tests to diagnose cirrhosis (liver biopsy) and portal hypertension (hepatic venous pressure gradient measurement and endoscopy) remain of crucial importance in several difficult clinical scenarios, but their need can be reduced by using different non-invasive tests in standard cases. Among non-invasive tests, the accepted use, major limitations and major benefits of serum markers of fibrosis, elastography and imaging methods are summarized in the present review.
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Affiliation(s)
- Bogdan Procopet
- University of Medicine and Pharmacy 'Iuliu Hatieganu', 3rd Medical Clinic and Hepatology Department, Regional Institute of Gastroenterology and Hepatology 'O Fodor', Cluj-Napoca, Romania
| | - Annalisa Berzigotti
- Swiss Liver Center, Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
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18
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Murphy IG, Graves MJ, Reid S, Patterson AJ, Patterson I, Priest AN, Lomas DJ. Comparison of breath-hold, respiratory navigated and free-breathing MR elastography of the liver. Magn Reson Imaging 2017; 37:46-50. [DOI: 10.1016/j.mri.2016.10.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 09/13/2016] [Accepted: 10/05/2016] [Indexed: 12/13/2022]
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19
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Payen T, Palermo CF, Sastra SA, Chen H, Han Y, Olive KP, Konofagou EE. Elasticity mapping of murine abdominal organs in vivo using harmonic motion imaging (HMI). Phys Med Biol 2016; 61:5741-54. [PMID: 27401609 PMCID: PMC5048218 DOI: 10.1088/0031-9155/61/15/5741] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Recently, ultrasonic imaging of soft tissue mechanics has been increasingly studied to image otherwise undetectable pathologies. However, many underlying mechanisms of tissue stiffening remain unknown, requiring small animal studies and adapted elasticity mapping techniques. Harmonic motion imaging (HMI) assesses tissue viscoelasticity by inducing localized oscillation from a periodic acoustic radiation force. The objective of this study was to evaluate the feasibility of HMI for in vivo elasticity mapping of abdominal organs in small animals. Pathological cases, i.e. chronic pancreatitis and pancreatic cancer, were also studied in vivo to assess the capability of HMI for detection of the change in mechanical properties. A 4.5 MHz focused ultrasound transducer (FUS) generated an amplitude-modulated beam resulting in 50 Hz harmonic tissue oscillations at its focus. Axial tissue displacement was estimated using 1D-cross-correlation of RF signals acquired with a 7.8 MHz diagnostic transducer confocally aligned with the FUS. In vitro results in canine liver and kidney showed the correlation between HMI displacement and Young's moduli measured by rheometry compression testing. HMI was capable of providing reproducible elasticity maps of the mouse abdominal region in vivo allowing the identification of, from stiffest to softest, the murine kidney, pancreas, liver, and spleen. Finally, pancreata affected by pancreatitis and pancreatic cancer showed HMI displacements 1.7 and 2.2 times lower than in the control case, respectively, indicating higher stiffness. The HMI displacement amplitude was correlated with the extent of fibrosis as well as detecting the very onset of stiffening even before fibrosis could be detected on H&E. This work shows that HMI can produce reliable elasticity maps of mouse abdominal region in vivo, thus providing a potentially critical tool to assess pathologies affecting organ elasticity.
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Affiliation(s)
- Thomas Payen
- Biomedical Engineering, Columbia University, USA
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20
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Lee DH, Lee JM, Yi NJ, Lee KW, Suh KS, Lee JH, Lee KB, Han JK. Hepatic stiffness measurement by using MR elastography: prognostic values after hepatic resection for hepatocellular carcinoma. Eur Radiol 2016; 27:1713-1721. [DOI: 10.1007/s00330-016-4499-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 06/23/2016] [Accepted: 06/29/2016] [Indexed: 02/08/2023]
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21
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Agostini A, Kircher MF, Do RKG, Borgheresi A, Monti S, Giovagnoni A, Mannelli L. Magnetic Resonanance Imaging of the Liver (Including Biliary Contrast Agents)-Part 2: Protocols for Liver Magnetic Resonanance Imaging and Characterization of Common Focal Liver Lesions. Semin Roentgenol 2016; 51:317-333. [PMID: 27743568 DOI: 10.1053/j.ro.2016.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Andrea Agostini
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Radiology, School of Radiology, Università Politecnica delle Marche, Ancona, Italy
| | - Moritz F Kircher
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Richard K G Do
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Alessandra Borgheresi
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Radiology, School of Radiology, Università degli Studi di Firenze, Firenze, Italy
| | | | - Andrea Giovagnoni
- Department of Radiology, School of Radiology, Università Politecnica delle Marche, Ancona, Italy
| | - Lorenzo Mannelli
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY.
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22
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Yuan Y. Imaging methods for evaluation of liver fibrosis. Shijie Huaren Xiaohua Zazhi 2016; 24:1532-1538. [DOI: 10.11569/wcjd.v24.i10.1532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Liver fibrosis is a development stage of various chronic liver diseases. Since liver fibrosis is still a reversible process, the development of irreversible cirrhosis can be delayed or prevented if the patient is early diagnosed and receives timely and effective treatment. Therefore, how to accurately, effectively and easily evaluate the severity of liver fibrosis remains a clinical problem to be solved. Ultrasound, CT and MRI are common examinations for hepatic lesions. Imaging examinations can non-invasively and accurately evaluate the degree of liver fibrosis. With the development and application of new imaging technologies, flexible technology has been widely applied in the assessment of liver fibrosis. This article reviews the application of various imaging modalities, especially elastic technology, for assessment of hepatic fibrosis.
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23
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Wu WP, Chou CT, Chen RC, Lee CW, Lee KW, Wu HK. Non-Invasive Evaluation of Hepatic Fibrosis: The Diagnostic Performance of Magnetic Resonance Elastography in Patients with Viral Hepatitis B or C. PLoS One 2015; 10:e0140068. [PMID: 26469342 PMCID: PMC4607490 DOI: 10.1371/journal.pone.0140068] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 09/20/2015] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To compare the accuracy of magnetic resonance elastography (MRE) with that of aspartate aminotransferase-to-platelet ratio index (APRI) for estimating the stage of hepatic fibrosis in patients with chronic hepatitis B virus (HBV) or chronic hepatitis C virus (HCV) infection. MATERIALS AND METHODS We retrospectively enrolled 160 patients with chronic hepatitis and 25 healthy living liver donors. Fibrosis stage (METAVIR, F0 to F4) was determined histopathologically for all patients. APRI was recorded at the time of histopathologic examination and liver stiffness values were measured on MRE quantitative stiffness maps. The cutoff values, sensitivity, and specificity of MRE and APRI for each fibrosis stage were determined using receiver operating characteristic (ROC) analysis. RESULTS MRE had a significantly greater area under the ROC curve than APRI score for discriminating among METAVIR stages F2-F4. Using a cutoff value of 2.80 kPa, MRE had a sensitivity of 94.4% and a specificity of 97.8% for detecting significant fibrosis (≥F2). There were no significant differences in fibrosis stage between patients with HBV and those with HCV infection. For ≥F2, the cutoffs were 2.47 kPa (100% sensitivity), 2.80 kP (maximum sum of sensitivity and specificity), and 3.70 kPa (100% specificity). CONCLUSIONS MRE is a more accurate modality than APRI for detecting significant fibrosis in patients with chronic HBV or HCV infection. Antiviral treatment should be considered in patients with liver stiffness values ≥ 2.8 kPa.
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Affiliation(s)
- Wen-Pei Wu
- Department of Diagnostic Radiology, Lu-Kang Christian Hospital, Changhua City, Taiwan, R.O.C
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei City, Taiwan, R.O.C
| | - Chen-Te Chou
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei City, Taiwan, R.O.C
- Department of Radiology, Chang-Hua Christian Hospital, Changhua City, Taiwan, R.O.C
- * E-mail: (CTC); (RCC)
| | - Ran-Chou Chen
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei City, Taiwan, R.O.C
- Department of Radiology, Taipei City Hospital, Taipei City, Taiwan, R.O.C
- * E-mail: (CTC); (RCC)
| | - Chih-Wei Lee
- Department of Radiology, Chang-Hua Christian Hospital, Changhua City, Taiwan, R.O.C
| | - Kwo-Whei Lee
- Department of Radiology, Chang-Hua Christian Hospital, Changhua City, Taiwan, R.O.C
| | - Hwa-Koon Wu
- Department of Radiology, Chang-Hua Christian Hospital, Changhua City, Taiwan, R.O.C
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Li B, Min J, Liang WR, Zhang GQ, Wu JJ, Jin K, Huang W, Ying CY, Chao M. Use of magnetic resonance elastography for assessing liver functional reserve: A clinical study. World J Gastroenterol 2015; 21:7522-7528. [PMID: 26139999 PMCID: PMC4481448 DOI: 10.3748/wjg.v21.i24.7522] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 01/14/2015] [Accepted: 03/31/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the value of magnetic resonance elastography (MRE) with regard to assessing liver functional reserve.
METHODS: Data from inpatients diagnosed with a liver tumor at an interventional radiology department from July 2013 to June 2014 were analyzed. A 3.0 Tesla magnetic resonance unit was used to scan 32 patients with confirmed diagnoses of hepatocellular carcinoma (HCC); an MRE sequence was added to the protocol, and the data were reconstructed and analyzed by two attending radiologists. Regions of interest were identified in different slices of the non-tumor liver parenchyma to measure average stiffness. In addition, the indocyanine green (ICG) test was performed no more than 1 wk before or after the magnetic resonance examination for all 32 patients; the ICG retention rate at 15 min (ICGR-15) and the ICG plasma clearance rate (ICG-K) were recorded. Correlational analyses were performed between the liver stiffness values and the ICGR-15 as well as between the liver stiffness values and the ICG-K.
RESULTS: Magnetic resonance imaging, including an MRE sequence and the ICG test, was performed successfully in all 32 enrolled patients. None of the patients developed complications. The mean ± SD of the elasticity values measured by the two attending radiologists were 4.7 ± 2.2 kPa and 4.7 ± 2.1 kPa, respectively. The average liver stiffness value of the non-tumor parenchyma measured using MRE in HCC patients was 4.7 ± 2.2 kPa. The average ICGR-15 was 0.089 ± 0.077, and the average ICG-K was 0.19 ± 0.07. We found that the liver stiffness value of the non-tumor parenchyma was significantly and positively related to the ICGR-15 (r = 0.746, P < 0.01) as well as significantly and negatively related to the ICG-K (r = -0.599, P < 0.01). The ICGR-15 was significantly and negatively related to the ICG-K (r = -0.852, P < 0.01).
CONCLUSION: MRE is accurate and non-invasive; furthermore, it can be used to effectively assess the liver functional reserve of HCC patients.
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25
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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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Forsgren MF, Norén B, Kihlberg J, Dahlqvist Leinhard O, Kechagias S, Lundberg P. Comparing hepatic 2D and 3D magnetic resonance elastography methods in a clinical setting - Initial experiences. Eur J Radiol Open 2015; 2:66-70. [PMID: 26937438 PMCID: PMC4750624 DOI: 10.1016/j.ejro.2015.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 04/13/2015] [Accepted: 04/15/2015] [Indexed: 12/18/2022] Open
Abstract
Purpose Continuous monitoring of liver fibrosis progression in patients is not feasible with the current diagnostic golden standard (needle biopsy). Recently, magnetic resonance elastography (MRE) has emerged as a promising method for such continuous monitoring. Since there are different MRE methods that could be used in a clinical setting there is a need to investigate whether measurements produced by these MRE methods are comparable. Hence, the purpose of this pilot study was to evaluate whether the measurements of the viscoelastic properties produced by 2D (stiffness) and 3D (elasticity and ‘Gabs,Elastic’) MRE are comparable. Materials and methods Seven patients with diffuse or suspect diffuse liver disease were examined in the same day with the two MRE methods. 2D MRE was performed using an acoustic passive transducer, with a 1.5 T GE 450 W MR system. 3D MRE was performed using an electromagnetic active transducer, with a 1.5 T Philips Achieva MR system. Finally, mean viscoelastic values were extracted from the same anatomical region for both methods by an experienced radiologist. Results Stiffness correlated well with the elasticity, R2 = 0.96 (P < 0.001; slope = 1.08, intercept = 0.61 kPa), as well as with ‘Gabs,Elastic’ R2 = 0.96 (P < 0.001; slope = 0.95, intercept = 0.28 kPa). Conclusion This pilot study shows that different MRE methods can produce comparable measurements of the viscoelastic properties of the liver. The existence of such comparable measurements is important, both from a clinical as well as a research perspective, since it allows for equipment-independent monitoring of disease progression.
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Affiliation(s)
- Mikael F Forsgren
- Wolfram MathCore AB, Linköping, Sweden; Center for Medical Image Science and Visualization (CMIV), Linköping University, SE-581 85 Linköping, Sweden; Radiation Physics, Division of Radiological Sciences, Department of Medical and Health Sciences (IMH), Linköping University, SE-581 83 Linköping, Sweden
| | - Bengt Norén
- Center for Medical Image Science and Visualization (CMIV), Linköping University, SE-581 85 Linköping, Sweden; Radiology, Division of Radiological Sciences, Department of Medical and Health Sciences (IMH), Linköping University, SE-581 83 Linköping, Sweden
| | - Johan Kihlberg
- Center for Medical Image Science and Visualization (CMIV), Linköping University, SE-581 85 Linköping, Sweden; Radiology, Division of Radiological Sciences, Department of Medical and Health Sciences (IMH), Linköping University, SE-581 83 Linköping, Sweden
| | - Olof Dahlqvist Leinhard
- Radiation Physics, Division of Radiological Sciences, Department of Medical and Health Sciences (IMH), Linköping University, SE-581 83 Linköping, Sweden; Center for Medical Image Science and Visualization (CMIV), Linköping University, SE-581 85 Linköping, Sweden
| | - Stergios Kechagias
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences (IMH), Linköping University, SE-581 83 Linköping, Sweden
| | - Peter Lundberg
- Center for Medical Image Science and Visualization (CMIV), Linköping University, SE-581 85 Linköping, Sweden; Radiation Physics, Division of Radiological Sciences, Department of Medical and Health Sciences (IMH), Linköping University, SE-581 83 Linköping, Sweden
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Kocakoc E, Bakan AA, Poyrazoglu OK, Dagli AF, Gul Y, Cicekci M, Bahcecioglu IH. Assessment of Liver Fibrosis with Diffusion-Weighted Magnetic Resonance Imaging Using Different b-values in Chronic Viral Hepatitis. Med Princ Pract 2015; 24:522-6. [PMID: 26183515 PMCID: PMC5588272 DOI: 10.1159/000434682] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 06/01/2015] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To examine the effectiveness of apparent diffusion coefficient (ADC) values and to compare the reliability of different b-values in detecting and identifying significant liver fibrosis. SUBJECTS AND METHODS There were 44 patients with chronic viral hepatitis (CVH) in the study group and 30 healthy participants in the control group. Diffusion-weighted magnetic resonance imaging (DWI) was performed before the liver biopsy in patients with CVH. The values of ADC were measured with 3 different b-values (100, 600, 1,000 s/mm2). In addition, liver fibrosis was classified using the modified Ishak scoring system. Liver fibrosis stages and ADC values were compared using areas under the receiver-operating characteristic (ROC) curve. RESULTS The study group's mean ADC value was not statistically significantly different from the control group's mean ADC value at b = 100 s/mm2 (3.69 ± 0.5 × 10-3 vs. 3.7 ± 0.3 × 10-3 mm2/s) and b = 600 s/mm2 (2.40 ± 0.3 × 10-3 vs. 2.5 ± 0.5 × 10-3 mm2/s). However, the study group's mean ADC value (0.99 ± 0.3 × 10-3 mm2/s) was significantly lower than that of the control group (1.2 ± 0.1 × 10-3 mm2/s) at b = 1,000 s/mm2. With b = 1,000 s/mm2 and the cutoff ADC value of 0.0011 mm2/s for the diagnosis of liver fibrosis, the mean area under the ROC curve was 0.702 ± 0.07 (p = 0.0015). For b = 1,000 s/mm2 and the cutoff ADC value of 0.0011 mm2/s to diagnose significant liver fibrosis (Ishak score = 3), the mean area under the ROC curve was 0.759 ± 0.07 (p = 0.0001). CONCLUSION Measurement of ADC values by DWI was effective in detecting liver fibrosis and accurately identifying significant liver fibrosis when a b-value of 1,000 s/mm2 was used.
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Affiliation(s)
- Ercan Kocakoc
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Elazig, Turkey
| | - Ayse Ahsen Bakan
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Elazig, Turkey
- *Ayse Ahsen Bakan, Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, TR-34093 Fatih, Istanbul (Turkey), E-Mail
| | | | - Adile Ferda Dagli
- Department of Pathology, Faculty of Medicine, Inonu University, Malatya, and Departments of, Elazig, Turkey
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Abstract
In this article, functional magnetic resonance (MR) imaging techniques in the abdomen are discussed. Diffusion-weighted imaging (DWI) increases the confidence in detecting and characterizing focal hepatic lesions. The potential uses of DWI in kidneys, adrenal glands, bowel, and pancreas are outlined. Studies have shown potential use of quantitative dynamic contrast-enhanced MR imaging parameters, such as K(trans), in predicting outcomes in cancer therapy. MR elastography is considered to be a useful tool in staging liver fibrosis. A major issue with all functional MR imaging techniques is the lack of standardization of the protocol.
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Affiliation(s)
- Kumar Sandrasegaran
- Department of Radiology, Indiana University School of Medicine, 550 N University Blvd, UH 0279, Indianapolis, IN 46202, USA.
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Lu R, Xiao Y, Liu M, Shi D. Ultrasound elastography in the differential diagnosis of benign and malignant cervical lesions. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:667-671. [PMID: 24658946 DOI: 10.7863/ultra.33.4.667] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES This study aimed to evaluate the clinical value of ultrasound elastography in the differential diagnosis of benign and malignant cervical lesions and to compare the accuracy of the elasticity score and strain ratio in differentiating cervical lesions. METHODS B-mode sonography and ultrasound elastography were performed on 84 cervical lesions (40 benign and 44 malignant) in 84 patients. All of the images were obtained transvaginally. The elasticity score was determined by a 5-point scoring method. Calculation of the strain ratio was based on a comparison of the average strain measured in the lesion with the adjacent tissue of the same depth, size, and shape. The findings were compared with histopathologic results. With the use of receiver operating characteristic curves, the diagnostic value of the elasticity score and strain ratio methods was determined. RESULTS The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the elasticity score in the differential diagnosis of cervical lesions were 81.8%, 85.0%, 83.3%, 85.7%, and 81.0%, respectively, whereas those of the strain ratio were 90.9%, 90.0%, 90.5%, 90.9%, and 90.0%. A strain ratio cutoff value of 4.525 was used as a standard to distinguish benign from malignant lesions. The strain ratio values of malignant lesions were much higher than those of benign lesions (range, 4.85-8.91 versus 0.62-4.50). The differences were statistically significant (P < .01). CONCLUSIONS Ultrasound elastography is a promising technique that is easy and rapid to perform and can help identify cervical lesions that are likely to be malignant. It is obvious that the strain ratio yielded better results than the elasticity score. Both methods are semiquantitative, but quantification of the strain ratio is finer than that of the elasticity score.
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Affiliation(s)
- Rong Lu
- Department of Ultrasonography, Xiangya Hospital, Central South University, 87 Xiangya Rd, 410008 Changsha, Hunan, China.
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Shahmirzadi D, Hou GY, Chen J, Konofagou EE. Ex Vivo characterization of canine liver tissue viscoelasticity after high-intensity focused ultrasound ablation. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:341-50. [PMID: 24315395 PMCID: PMC4005882 DOI: 10.1016/j.ultrasmedbio.2013.09.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 08/24/2013] [Accepted: 09/12/2013] [Indexed: 05/12/2023]
Abstract
The potential of elasticity imaging to detect high-intensity focused ultrasound (HIFU) lesions on the basis of their distinct biomechanical properties is promising. However, information on the quantitative mechanical properties of the tissue and the optimal intensity at which to determine the best contrast parameters is scarce. In this study, fresh canine livers were ablated using combinations of ISPTA intensities of 5.55, 7.16 and 9.07 kW/cm(2) and durations of 10 and 30 s ex vivo, resulting in six groups of ablated tissues. Biopsy samples were then interrogated using dynamic shear mechanical testing within the range of 0.1-10 Hz to characterize the tissue's post-ablation viscoelastic properties. All mechanical parameters were found to be frequency dependent. Compared with unablated cases, all six groups of ablated tissues had statistically significant higher complex shear modulus and shear viscosity. However, among the ablated groups, both complex shear modulus and shear viscosity were found to monotonically increase in groups 1-4 (5.55 kW/cm(2) for 10 s, 7.16 kW/cm(2) for 10 s, 9.07 kW/cm(2) for 10 s, and 5.55 kW/cm(2) for 30 s, respectively), but to decrease in groups 5 and 6 (7.16 kW/cm(2) for 30 s, and 9.07 kW/cm(2) for 30 s, respectively). For groups 5 and 6, the temperature was expected to exceed the boiling point, and therefore, the decreased stiffening could be due to the compromised integrity of the tissue microstructure. Future studies will entail estimation tissue mechanical properties in vivo and perform real-time monitoring of tissue alterations during ablation.
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Affiliation(s)
- Danial Shahmirzadi
- Ultrasound and Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Gary Y Hou
- Ultrasound and Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Jiangang Chen
- Ultrasound and Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Elisa E Konofagou
- Ultrasound and Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York, USA; Department of Radiology, Columbia University, New York, New York, USA.
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Microcomputed tomography with diffraction-enhanced imaging for morphologic characterization and quantitative evaluation of microvessel of hepatic fibrosis in rats. PLoS One 2013; 8:e78176. [PMID: 24205147 PMCID: PMC3804625 DOI: 10.1371/journal.pone.0078176] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 09/09/2013] [Indexed: 12/12/2022] Open
Abstract
Backgroud Hepatic fibrosis can lead to deformation of vessel morphology and structure. In the present feasibility study, high-resolution computed tomography (CT) using diffraction-enhanced imaging (DEI) was used to represent three-dimensional (3D) vessel microstructures of hepatic fibrosis in rats and to differentiate different stages of hepatic fibrosis using qualitative descriptions and quantitative measurement of microvessels. Material and Methods Three typical specimens at different stages, i.e., mild, moderate and severe hepatic fibrosis, were imaged using DEI at 15 keV without contrast agents. The correspondence between DEI-CT images and histopathological findings was determined. The 3D visualizations from different stages of hepatic fibrosis were presented using DEI-CT. Additionally, Qualitative descriptions and quantitative evaluation of vessel features, such as vessel trend, vascular distortion deformation, thrombus formation and texture features on the inner wall of the vessel, were performed. Results DEI-CT produced high-resolution images of the vessel microstructures in hepatic fibrosis that corresponded to information on actual structures observed from the histological sections. Combined with the 3D visualization technique, DEI-CT enabled the acquisition of an accurate description of the 3D vessel morphology from different stages of hepatic fibrosis. Qualitative descriptions and quantitative assessment of microvessels demonstrated clear differences between the different stages of hepatic fibrosis. The thrombus inside the vessel of severe liver fibrosis was accurately displayed, and corresponding analysis can provide an exact measurement of vessel stenosis rate. Conclusions DEI-CT may allow morphologic descriptions and quantitative evaluation of vessel microstructures from different stages of hepatic fibrosis and can better characterize the various stages of fibrosis progression using high-resolution 3D vessel morphology.
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Measuring hepatic functional reserve using low temporal resolution Gd-EOB-DTPA dynamic contrast-enhanced MRI: a preliminary study comparing galactosyl human serum albumin scintigraphy with indocyanine green retention. Eur Radiol 2013; 24:112-9. [PMID: 23949726 DOI: 10.1007/s00330-013-2983-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 06/23/2013] [Accepted: 06/27/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate if tracer kinetic modelling of low temporal resolution dynamic contrast-enhanced (DCE) MRI with Gd-EOB-DTPA could replace technetium-99 m galactosyl human serum albumin (GSA) single positron emission computed tomography (SPECT) and indocyanine green (ICG) retention for the measurement of liver functional reserve. METHODS Twenty eight patients awaiting liver resection for various cancers were included in this retrospective study that was approved by the institutional review board. The Gd-EOB-DTPA MRI sequence acquired five images: unenhanced, double arterial phase, portal phase, and 4 min after injection. Intracellular contrast uptake rate (UR) and extracellular volume (Ve) were calculated from DCE-MRI, along with the ratio of GSA radioactivity of liver to heart-plus-liver and per cent of cumulative uptake from 15-16 min (LHL15 and LU15, respectively) from GSA-scintigraphy. ICG retention at 15 min, Child-Pugh cirrhosis score (CPS) and postoperative Inuyama fibrosis criteria were also recorded. Statistical analysis was with Spearman rank correlation analysis. RESULTS Comparing MRI parameters with the reference methods, significant correlations were obtained for UR and LHL15, LU15, ICG15 (all 0.4-0.6, P < 0.05); UR and CPS (-0.64, P < 0.001); Ve and Inuyama (0.44, P < 0.05). CONCLUSION Measures of liver function obtained by routine Gd-EOB-DTPA DCE-MRI with tracer kinetic modelling may provide a suitable method for the evaluation of liver functional reserve. KEY POINTS • Magnetic resonance imaging (MRI) provides new methods of measuring hepatic functional reserve. • DCE-MRI with Gd-EOB-DTPA offers the possibility of replacing scintigraphy. • The analysis method can be used for preoperative liver function evaluation.
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