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Anders M, Meyer T, Warmuth C, Pfeuffer J, Tzschaetzsch H, Herthum H, Shahryari M, Degenhardt K, Wieben O, Schmitter S, Schulz-Menger J, Schaeffter T, Braun J, Sack I. Rapid MR elastography of the liver for subsecond stiffness sampling. Magn Reson Med 2024; 91:312-324. [PMID: 37705467 DOI: 10.1002/mrm.29859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE Depicting the stiffness of biological soft tissues, MR elastography (MRE) has a wide range of diagnostic applications. The purpose of this study was to improve the temporal resolution of 2D hepatic MRE in order to provide more rapid feedback on the quality of the wavefield and ensure better temporal sampling of respiration-induced stiffness changes. METHODS We developed a rapid MRE sequence that uses 2D segmented gradient-echo spiral readout to encode 40 Hz harmonic vibrations and generate stiffness maps within 625 ms. We demonstrate the use of this technique as a rapid test for shear wave amplitudes and overall MRE image quality and as a method for monitoring respiration-induced stiffness changes in the liver in comparison to 3D MRE and ultrasound-based time-harmonic elastography. RESULTS Subsecond MRE allowed monitoring of increasing shear wave amplitudes in the liver with increasing levels of external stimulation within a single breath-hold. Furthermore, the technique detected respiration-induced changes in liver stiffness with peak values (1.83 ± 0.22 m/s) at end-inspiration, followed by softer values during forced abdominal pressure (1.60 ± 0.22 m/s) and end-expiration (1.49 ± 0.22 m/s). The effects of inspiration and expiration were confirmed by time-harmonic elastography. CONCLUSION Our results suggest that subsecond MRE of the liver is useful for checking MRE driver settings and monitoring breathing-induced changes in liver stiffness in near real time.
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Affiliation(s)
- Matthias Anders
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tom Meyer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Carsten Warmuth
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Josef Pfeuffer
- Application Development, Siemens Healthcare GmbH, Erlangen, Germany
| | - Heiko Tzschaetzsch
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Helge Herthum
- Berlin Center for Advanced Neuroimaging (BCAN), Berlin, Germany, Corporate Member of Freie Universität Berlin, Berlin Institute of Health and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mehrgan Shahryari
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Katja Degenhardt
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Berlin, Germany
| | - Oliver Wieben
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Sebastian Schmitter
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Berlin, Germany
| | - Jeanette Schulz-Menger
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Working Group On CMR, Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité-Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
- Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany
| | - Tobias Schaeffter
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Berlin, Germany
- Department of Medical Engineering, Technische Universität Berlin, Einstein Centre Digital Future, Berlin, Germany
| | - Juergen Braun
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ingolf Sack
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Safraou Y, Krehl K, Meyer T, Mehrgan S, Jordan JEL, Tzschätzsch H, Fischer T, Asbach P, Braun J, Sack I, Guo J. The influence of static portal pressure on liver biophysical properties. Acta Biomater 2023; 169:118-129. [PMID: 37507032 DOI: 10.1016/j.actbio.2023.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/03/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023]
Abstract
The liver is a highly vascularized organ where fluid properties, including vascular pressure, vessel integrity and fluid viscosity, play a critical role in gross mechanical properties. To study the effects of portal pressure, liver confinement, fluid viscosity, and tissue crosslinking on liver stiffness, water diffusion, and vessel size, we applied multiparametric magnetic resonance imaging (mpMRI), including multifrequency magnetic resonance elastography (MRE) and apparent diffusion coefficient (ADC) measurements, to ex vivo livers from healthy male rats (13.6±1.6 weeks) at room temperature. Four scenarios including altered liver confinement, tissue crosslinking, and vascular fluid viscosity were investigated with mpMRI at different portal pressure levels (0-17.5 cmH2O). Our experiments demonstrated that, with increasing portal pressure, rat livers showed higher water content, water diffusivity, and increased vessel sizes quantified by the vessel tissue volume fraction (VTVF). These effects were most pronounced in native, unconfined livers (VTVF: 300±120%, p<0.05, ADC: 88±29%, p<0.01), while still significant under confinement (confined: VTVF: 53±32%, p<0.01, ADC: 28±19%, p<0.05; confined-fixed: VTVF: 52±20%, p<0.001, ADC: 11±2%, p<0.01; confined-viscous: VTVF: 210±110%, p<0.01, ADC: 26±9%, p<0.001). Softening with elevated portal pressure (-12±5, p<0.05) occurred regardless of confinement and fixation. However, the liver stiffened when exposed to a more viscous inflow fluid (11±4%, p<0.001). Taken together, our results elucidate the complex relationship between macroscopic-biophysical parameters of liver tissue measured by mpMRI and vascular-fluid properties. Influenced by portal pressure, vascular permeability, and matrix crosslinking, liver stiffness is sensitive to intrinsic poroelastic properties, which, alongside vascular architecture and water diffusivity, may aid in the differential diagnosis of liver disease. STATEMENT OF SIGNIFICANCE: Using highly controllable ex vivo rat liver phantoms, hepatic biophysical properties such as tissue-vascular structure, stiffness, and water diffusivity were investigated using multiparametric MRI including multifrequency magnetic resonance elastography (MRE) and diffusion-weighted imaging (DWI). Through elaborate tuning of the experimental conditions such as the static portal pressure, flow viscosity, amount and distribution of fluid content in the liver, we identified the contributions of the fluid component to the overall imaging-based biophysical properties of the liver. Our finding demonstrated the sensitivity of liver stiffness to the hepatic poroelastic properties, which may aid in the differential diagnosis of liver diseases.
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Affiliation(s)
- Yasmine Safraou
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Karolina Krehl
- Department of Veterinary Medicine, Institute of Animal Welfare, Animal Behavior and Laboratory Animal Science, Freie Universität Berlin
| | - Tom Meyer
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Shahryari Mehrgan
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jakob Ernst Luis Jordan
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Heiko Tzschätzsch
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Thomas Fischer
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Patrick Asbach
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jürgen Braun
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ingolf Sack
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jing Guo
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
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Aleef TA, Zeng Q, Moradi H, Mohammed S, Curran T, Honarvar M, Rohling R, Mahdavi SS, Salcudean SE. 3-D Transducer Mounted Shear Wave Absolute Vibro-Elastography: Proof of Concept. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2023; 70:1026-1038. [PMID: 37027576 DOI: 10.1109/tuffc.2023.3249795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Quantitative tissue stiffness characterization using ultrasound (US) has been shown to improve prostate cancer (PCa) detection in multiple studies. Shear wave absolute vibro-elastography (SWAVE) allows quantitative and volumetric assessment of tissue stiffness using external multifrequency excitation. This article presents a proof of concept of a first-of-a-kind 3-D hand-operated endorectal SWAVE system designed to be used during systematic prostate biopsy. The system is developed with a clinical US machine, requiring only an external exciter that can be mounted directly to the transducer. Subsector acquisition of radio frequency (RF) data allows imaging of shear waves with a high effective frame rate (up to 250 Hz). The system was characterized using eight different quality assurance phantoms. Due to the invasive nature of prostate imaging, at this early stage of development, validation of in vivo human tissue was instead carried out by intercostally scanning the livers of n = 7 healthy volunteers. The results are compared with 3-D magnetic resonance elastography (MRE) and an existing 3-D SWAVE system with a matrix array transducer (M-SWAVE). High correlations were found with MRE (99% in phantoms, 94% in liver data) and with M-SWAVE (99% in phantoms, 98% in liver data).
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Jugé L, Foley P, Hatt A, Yeung J, Bilston LE. Ex vivo bovine liver nonlinear viscoelastic properties: MR elastography and rheological measurements. J Mech Behav Biomed Mater 2023; 138:105638. [PMID: 36623403 DOI: 10.1016/j.jmbbm.2022.105638] [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: 10/04/2022] [Revised: 11/28/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Knowledge of the nonlinear viscoelastic properties of the liver is important, but the complex tissue behavior outside the linear viscoelastic regime has impeded their characterization, particularly in vivo. Combining static compression with magnetic resonance (MR) elastography has the potential to be a useful imaging method for assessing large deformation mechanical properties of soft tissues in vivo. However, this remains to be verified. Therefore this study aims first to determine whether MR elastography can measure the nonlinear mechanical properties of ex vivo bovine liver tissue under varying levels of uniform and focal preloads (up to 30%), and second to compare MR elastography-derived complex shear modulus with standard rheological measurements. METHOD Nine fresh bovine livers were collected from a local abattoir, and experiments were conducted within 12hr of death. Two cubic samples (∼10 × 10 × 10 cm3) were dissected from each liver and imaged using MR elastography (60 Hz) under 4 levels of uniform and focal preload (1, 10, 20, and 30% of sample width) to investigate the relationship between MR elastography-derived complex shear modulus (G∗) and the maximum principal Right Cauchy Green Strain (C11). Three tissue samples from each of the same 9 livers underwent oscillatory rheometry under the same 4 preloads (1, 10, 20, and 30% strain). MR elastography-derived complex shear modulus (G∗) from the uniform preload was validated against rheometry by fitting the frequency dependence of G∗ with a power-law and extrapolating rheometry-derived G∗ to 60 Hz. RESULTS MR elastography-derived G∗ increased with increasing compressive large deformation strain, and followed a power-law curve (G∗ = 1.73 × C11-0.38, R2 = 0.96). Similarly, rheometry-derived G∗ at 1 Hz, increasing from 0.66 ± 1.03 kPa (1% strain) to 1.84 ± 1.65 kPa (30% strain, RM one-way ANOVA, P < 0.001), and the frequency dependence of G∗ followed a power-law with the exponent decreasing from 0.13 to 0.06 with increasing preload. MR elastography-derived G∗ was 1.4-3.1 times higher than the extrapolated rheometry-derived G∗ at 60 Hz, but the strain dependence was consistent between rheometry and MR elastography measurements. CONCLUSIONS This study demonstrates that MR elastography can detect changes in ex vivo bovine liver complex shear modulus due to either uniform or focal preload and therefore can be a useful technique to characterize nonlinear viscoelastic properties of soft tissue, provided that strains applied to the tissue can be quantified. Although MR elastography could reliably characterize the strain dependence of the ex vivo bovine liver, MR elastography overestimated the complex shear modulus of the tissue compared to rheological measurements, particularly at lower preload (<10%). That is likely to be important in clinical hepatic MR elastography diagnosis studies if preload is not carefully considered. A limitation is the absence of overlapping frequency between rheometry and MR elastography for formal validation.
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Affiliation(s)
- Lauriane Jugé
- Neuroscience Research Australia, PO Box 1165, Randwick NSW 2031, Australia; University of New South Wales, Faculty of Medicine & Health, UNSW Sydney, 18 High St, Kensington NSW 2052, Australia
| | - Patrick Foley
- Neuroscience Research Australia, PO Box 1165, Randwick NSW 2031, Australia
| | - Alice Hatt
- Neuroscience Research Australia, PO Box 1165, Randwick NSW 2031, Australia
| | - Jade Yeung
- Neuroscience Research Australia, PO Box 1165, Randwick NSW 2031, Australia
| | - Lynne E Bilston
- Neuroscience Research Australia, PO Box 1165, Randwick NSW 2031, Australia; University of New South Wales, Faculty of Medicine & Health, UNSW Sydney, 18 High St, Kensington NSW 2052, Australia.
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Shahryari M, Keller S, Meierhofer D, Wallach I, Safraou Y, Guo J, Marticorena Garcia SR, Braun J, Makowski MR, Sack I, Berndt N. On the relationship between metabolic capacities and in vivo viscoelastic properties of the liver. Front Bioeng Biotechnol 2023; 10:1042711. [PMID: 36698634 PMCID: PMC9868178 DOI: 10.3389/fbioe.2022.1042711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
The liver is the central metabolic organ. It constantly adapts its metabolic capacity to current physiological requirements. However, the relationship between tissue structure and hepatic function is incompletely understood; this results in a lack of diagnostic markers in medical imaging that can provide information about the liver's metabolic capacity. Therefore, using normal rabbit livers, we combined magnetic resonance elastography (MRE) with proteomics-based kinetic modeling of central liver metabolism to investigate the potential role of MRE for predicting the liver's metabolic function in vivo. Nineteen New Zealand white rabbits were investigated by multifrequency MRE and positron emission tomography (PET). This yielded maps of shear wave speed (SWS), penetration rate (PR) and standardized uptake value (SUV). Proteomic analysis was performed after the scans. Hepatic metabolic functions were assessed on the basis of the HEPATOKIN1 model in combination with a model of hepatic lipid-droplet metabolism using liquid chromatography-mass spectrometry. Our results showed marked differences between individual livers in both metabolic functions and stiffness properties, though not in SUV. When livers were divided into 'stiff' and 'soft' subgroups (cutoff SWS = 1.6 m/s), stiff livers showed a lower capacity for triacylglycerol storage, while at the same time showing an increased capacity for gluconeogenesis and cholesterol synthesis. Furthermore, SWS was correlated with gluconeogenesis and PR with urea production and glutamine exchange. In conclusion, our study indicates a close relationship between the viscoelastic properties of the liver and metabolic function. This could be used in future studies to predict non-invasively the functional reserve capacity of the liver in patients.
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Affiliation(s)
- Mehrgan Shahryari
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sarah Keller
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - David Meierhofer
- Mass Spectrometry Facility, Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - Iwona Wallach
- Institute of Computer-Assisted Cardiovascular Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Yasmine Safraou
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jing Guo
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stephan R. Marticorena Garcia
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jürgen Braun
- Institute of Medical Informatics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marcus R. Makowski
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Faculty of Medicine, Munich, Germany
| | - Ingolf Sack
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nikolaus Berndt
- Institute of Computer-Assisted Cardiovascular Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,*Correspondence: Nikolaus Berndt,
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Li Y, Gao Q, Chen N, Zhang Y, Wang J, Li C, He X, Jiao Y, Zhang Z. Clinical studies of magnetic resonance elastography from 1995 to 2021: Scientometric and visualization analysis based on CiteSpace. Quant Imaging Med Surg 2022; 12:5080-5100. [PMID: 36330182 PMCID: PMC9622435 DOI: 10.21037/qims-22-207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/11/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND To assess the knowledge framework around magnetic resonance elastography (MRE) and to explore MRE research hotspots and emerging trends. METHODS The Science Citation Index Expanded of the Web of Science Core Collection was searched on 22 October 2021 for MRE-related studies published between 1995 and 2021. Excel 2016 and CiteSpace V (version 5.8.R3) were used to analyze the downloaded data. RESULTS In all, 1,236 articles published by 726 authors from 540 institutions in 40 countries were included in this study. The top 10 authors published 57.6% of all included articles. The 3 most productive countries were the USA (n=631), Germany (n=202), and France (n=134), and the 3 most productive institutions were the Mayo Clinic (n=240), Charité (n=131), and the University of Illinois (n=56). The USA and the Mayo Clinic had the highest betweenness centrality among countries and institutions, respectively, and played an important role in the field of MRE. In this study, the 24,347 distinct references were clustered into 48 categories via reasonable clustering using specific keywords, forming the knowledge framework. Among the 294 co-occurring keywords, "hepatic fibrosis", "stiffness", "skeletal muscle", "acoustic strain wave", "in vivo", and "non-invasive assessment" were research hotspots. "Diagnostic performance", "diagnostic accuracy", "hepatic steatosis", "chronic hepatitis B", "radiation force impulse", "children", and "echo" were frontier topics. CONCLUSIONS Scientometric and visualized analysis of MRE can provide information regarding the knowledge framework, research hotspots, frontier areas, and emerging trends in this field.
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Affiliation(s)
- Youwei Li
- Department of Radiology, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Qiang Gao
- Department of Gastroenterology and Hepatology, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Na Chen
- Department of Otorhinolaryngology, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Yuanfang Zhang
- Department of Radiology, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Juan Wang
- Department of Radiology, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Chang Li
- Department of Radiology, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Xuan He
- Department of Radiology, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Yang Jiao
- Department of Rehabilitation Psychology, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Zongming Zhang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing, China
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Dillman JR, Tkach JA, Pedneker A, Trout AT. Quantitative abdominal magnetic resonance imaging in children-special considerations. Abdom Radiol (NY) 2022; 47:3069-3077. [PMID: 34196762 DOI: 10.1007/s00261-021-03191-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/20/2021] [Accepted: 06/21/2021] [Indexed: 01/18/2023]
Abstract
The use of quantitative MRI methods for assessment of the abdomen in children has become commonplace over the past decade. Increasingly employed methods include MR elastography, chemical shift encoded (CSE) MR imaging for determination of proton density fat fraction, diffusion-weighted imaging, and a variety of relaxometry techniques, such as T1 and T2* mapping. These techniques can be used in a variety of settings to distinguish normal from abnormal tissue as well as determine the severity of disease. The performance of quantitative MRI methods in the pediatric population presents unique challenges as compared to adult populations. These challenges relate to multiple factors, including patient size, pediatric physiology, inability to breath hold, and greater physical motion during the examination. The purpose of this review article is to review quantitative MRI methods that may be used in clinical practice to assess the pediatric abdomen and to discuss special considerations when performing these techniques in children.
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Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Amol Pedneker
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Kennedy P, Stocker D, Carbonell G, Said D, Bane O, Hectors S, Abboud G, Cuevas J, Bolster BD, Friedman SL, Lewis S, Schiano T, Bhattacharya D, Fischman A, Thung S, Taouli B. MR elastography outperforms shear wave elastography for the diagnosis of clinically significant portal hypertension. Eur Radiol 2022; 32:8339-8349. [PMID: 35727321 PMCID: PMC10149092 DOI: 10.1007/s00330-022-08935-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 05/11/2022] [Accepted: 05/30/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Portal hypertension (PH) is associated with complications such as ascites and esophageal varices and is typically diagnosed through invasive hepatic venous pressure gradient (HVPG) measurement, which is not widely available. In this study, we aim to assess the diagnostic performance of 2D/3D MR elastography (MRE) and shear wave elastography (SWE) measures of liver and spleen stiffness (LS and SS) and spleen volume, to noninvasively diagnose clinically significant portal hypertension (CSPH) using HVPG measurement as the reference. METHODS In this prospective study, patients with liver disease underwent 2D/3D MRE and SWE of the liver and spleen, as well as HVPG measurement. The correlation between MRE/SWE measures of LS/SS and spleen volume with HVPG was assessed. ROC analysis was used to determine the utility of MRE, SWE, and spleen volume for diagnosing CSPH. RESULTS Thirty-six patients (M/F 22/14, mean age 55 ± 14 years) were included. Of the evaluated parameters, 3D MRE SS had the strongest correlation with HVPG (r = 0.686, p < 0.001), followed by 2D MRE SS (r = 0.476, p = 0.004). 3D MRE SS displayed the best performance for diagnosis of CSPH (AUC = 0.911) followed by 2D MRE SS (AUC = 0.845) and 3D MRE LS (AUC = 0.804). SWE SS showed poor performance for diagnosis of CSPH (AUC = 0.583) while spleen volume was a fair predictor (AUC = 0.738). 3D MRE SS was significantly superior to SWE LS/SS (p ≤ 0.021) for the diagnosis of CSPH. CONCLUSION SS measured with 3D MRE outperforms SWE for the diagnosis of CSPH. SS appears to be a useful biomarker for assessing PH severity. These results need further validation. KEY POINTS • Spleen stiffness measured with 2D and 3D MR elastography correlates significantly with hepatic venous pressure gradient measurement. • Spleen stiffness measured with 3D MR elastography demonstrates excellent performance for the diagnosis of clinically significant portal hypertension (AUC 0.911). • Spleen stiffness measured with 3D MR elastography outperforms liver and spleen stiffness measured with shear wave elastography for diagnosis of clinically significant portal hypertension.
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Affiliation(s)
- Paul Kennedy
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel Stocker
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Guillermo Carbonell
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Universidad de Murcia, Murcia, Spain
| | - Daniela Said
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Universidad de los Andes, Santiago, Chile
| | - Octavia Bane
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stefanie Hectors
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ghadi Abboud
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jordan Cuevas
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Scott L Friedman
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sara Lewis
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Thomas Schiano
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dipankar Bhattacharya
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aaron Fischman
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Swan Thung
- Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bachir Taouli
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY, 10029, USA.
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9
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Li B, Li J, Zhang Y, Chu Z, Zhang L, Ji Q. Dynamic changes of hepatic microenvironment related to graft function in donation after cardiac death liver transplantation. Eur J Radiol 2022; 154:110424. [DOI: 10.1016/j.ejrad.2022.110424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/31/2022] [Accepted: 06/22/2022] [Indexed: 11/30/2022]
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10
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Oechtering TH, Roberts GS, Panagiotopoulos N, Wieben O, Reeder SB, Roldán-Alzate A. Clinical Applications of 4D Flow MRI in the Portal Venous System. Magn Reson Med Sci 2022; 21:340-353. [PMID: 35082218 PMCID: PMC9680553 DOI: 10.2463/mrms.rev.2021-0105] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/13/2021] [Indexed: 09/27/2023] Open
Abstract
Evaluation of the hemodynamics in the portal venous system plays an essential role in many hepatic pathologies. Changes in portal flow and vessel morphology are often indicative of disease.Routinely used imaging modalities, such as CT, ultrasound, invasive angiography, and MRI, often focus on either hemodynamics or anatomical imaging. In contrast, 4D flow MRI facilitiates a more comprehensive understanding of pathophysiological mechanisms by simultaneously and noninvasively acquiring time-resolved flow and anatomical information in a 3D imaging volume.Though promising, 4D flow MRI in the portal venous system is especially challenging due to small vessel calibers, slow flow velocities, and breathing motion. In this review article, we will discuss how to account for these challenges when planning and conducting 4D flow MRI acquisitions in the upper abdomen. We will address patient preparation, sequence acquisition, postprocessing, quality control, and analysis of 4D flow data.In the second part of this article, we will review potential clinical applications of 4D flow MRI in the portal venous system. The most promising area for clinical utilization is the diagnosis and grading of liver cirrhosis and its complications. Relevant parameters acquired by 4D flow MRI include the detection of reduced or reversed flow in the portal venous system, characterization of portosystemic collaterals, and impaired response to a meal challenge. In patients with cirrhosis, 4D flow MRI has the potential to address the major unmet need of noninvasive detection of gastroesophageal varices at high risk for bleeding. This could replace many unnecessary, purely diagnostic, and invasive esophagogastroduodenoscopy procedures, thereby improving patient compliance with follow-up. Moreover, 4D flow MRI offers unique insights and added value for surgical planning and follow-up of multiple hepatic interventions, including transjugular intrahepatic portosystemic shunts, liver transplantation, and hepatic disease in children. Lastly, we will discuss the path to clinical implementation and remaining challenges.
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Affiliation(s)
- Thekla H. Oechtering
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Department of Radiology, Universität zu Lübeck, Luebeck, Germany
| | - Grant S. Roberts
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Nikolaos Panagiotopoulos
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Department of Radiology, Universität zu Lübeck, Luebeck, Germany
| | - Oliver Wieben
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Scott B. Reeder
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
- Department of Mechanical Engineering, University of Wisconsin, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA
- Department of Emergency, University of Wisconsin Medicine, Madison, WI, USA
| | - Alejandro Roldán-Alzate
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Department of Mechanical Engineering, University of Wisconsin, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA
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11
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Boursier J, Decraecker M, Bourlière M, Bureau C, Ganne-Carrié N, de Lédinghen V. Quality criteria for the measurement of liver stiffness. Clin Res Hepatol Gastroenterol 2022; 46:101761. [PMID: 34325013 DOI: 10.1016/j.clinre.2021.101761] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 07/23/2021] [Indexed: 02/04/2023]
Abstract
Liver elastography offers the possibility of a quick, non-invasive, and painless evaluation of the liver with immediate results at bedside. Transient elastography is the most validated technology, and many others such as point shear wave elastography, 2D-shear wave elastography, or magnetic resonance elastography have been developed. To ensure the best evaluation, several conditions of examination must be respected for liver stiffness measurement. Indeed, patient, operator and examination characteristics have all been shown to influence the result of liver stiffness measurement. Food intake increases liver stiffness, whereas withdrawal in alcoholics is associated with a decrease in elastography results. Inter-observer reproducibility of the measurement seems suboptimal, and the influence of the operator experience is still being debated. The measurement site and the FibroScan® probe must be correctly chosen. Finally, the intrinsic characteristics and quality criteria of the measurement, especially the interquartile range/median ratio, must be carefully checked to avoid overestimation of liver stiffness. Most of the results come from studies which have evaluated transient elastography, with less data available for the other technologies. Liver stiffness measurement could appear as a simple way to explore the liver, but several conditions must be met before deciding the patient management according to its result.
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Affiliation(s)
- Jérôme Boursier
- Laboratoire HIFIH, UPRES EA3859, SFR ICAT 4208, Université d'Angers, Angers, France.
| | - Marie Decraecker
- Service d'hépato-gastroentérologie, Hôpital Haut-Lévêque, CHU Bordeaux, pessac & INSERM U1053, Université de Bordeaux, Bordeaux, France
| | - Marc Bourlière
- Service d'hépato-gastroentérologie, Hôpital Saint Joseph & INSERM UMR 1252 IRD SESSTIM Aix Marseille Université, Marseille, France
| | - Christophe Bureau
- Service d'hépatologie, Hôpital Rangueil, CHU Toulouse, Toulouse, France
| | - Nathalie Ganne-Carrié
- Service d'hépatologie, Hôpital Avicenne, APHP, Université Sorbonne Paris Nord, Bobigny & INSERM UMR 1138, Centre de Recherche des Cordeliers, Université de Paris, France
| | - Victor de Lédinghen
- Service d'hépato-gastroentérologie, Hôpital Haut-Lévêque, CHU Bordeaux, pessac & INSERM U1053, Université de Bordeaux, Bordeaux, France
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12
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Bontzos G, Douglas VP, Douglas KAA, Kapsala Z, Drakonaki EE, Detorakis ET. Ultrasound Elastography in Ocular and Periocular Tissues: A Review. Curr Med Imaging 2021; 17:1041-1053. [PMID: 33319691 DOI: 10.2174/1573405616666201214123117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/31/2020] [Accepted: 10/15/2020] [Indexed: 11/22/2022]
Abstract
Ultrasound elastography has become available in everyday practice, allowing direct measurement of tissue elasticity with important and expanding clinical applications. Several studies that have evaluated pathological and non-pathological tissues have demonstrated that ultrasound elastography can actually improve the diagnostic accuracy of the underlying disease process by detecting differences in their elasticity. Ocular and periocular tissues can also be characterized by their elastic properties. In this context, a comprehensive review of literature on ultrasound elastography as well as its current applications in Ophthalmology is presented.
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Affiliation(s)
- Georgios Bontzos
- Department of Ophthalmology, University Hospital of Heraklion, Crete, Greece
| | | | | | - Zoi Kapsala
- Department of Ophthalmology, University Hospital of Heraklion, Crete, Greece
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13
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Chouhan MD, Fitzke HE, Bainbridge A, Atkinson D, Halligan S, Davies N, Lythgoe MF, Mookerjee RP, Menys A, Taylor SA. Cardiac-induced liver deformation as a measure of liver stiffness using dynamic imaging without magnetization tagging-preclinical proof-of-concept, clinical translation, reproducibility and feasibility in patients with cirrhosis. Abdom Radiol (NY) 2021; 46:4660-4670. [PMID: 34148103 DOI: 10.1007/s00261-021-03168-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/03/2021] [Accepted: 06/05/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE MR elastography and magnetization-tagging use liver stiffness (LS) measurements to diagnose fibrosis but require physical drivers, specialist sequences and post-processing. Here we evaluate non-rigid registration of dynamic two-dimensional cine MRI images to measure cardiac-induced liver deformation (LD) as a measure of LS by (i) assessing preclinical proof-of-concept, (ii) clinical reproducibility and inter-reader variability, (iii) the effects of hepatic hemodynamic changes and (iv) feasibility in patients with cirrhosis. METHODS Sprague-Dawley rats (n = 21 bile duct ligated (BDL), n = 17 sham-operated controls) and fasted patients with liver cirrhosis (n = 11) and healthy volunteers (HVs, n = 10) underwent spoiled gradient-echo short-axis cardiac cine MRI studies at 9.4 T (rodents) and 3.0 T (humans). LD measurements were obtained from intrahepatic sub-cardiac regions-of-interest close to the diaphragmatic margin. One-week reproducibility and prandial stress induced hemodynamic changes were assessed in healthy volunteers. RESULTS Normalized LD was higher in BDL (1.304 ± 0.062) compared with sham-operated rats (1.058 ± 0.045, P = 0.0031). HV seven-day reproducibility Bland-Altman (BA) limits-of-agreement (LoAs) were ± 0.028 a.u. and inter-reader variability BA LoAs were ± 0.030 a.u. Post-prandial LD increases were non-significant (+ 0.0083 ± 0.0076 a.u., P = 0.3028) and uncorrelated with PV flow changes (r = 0.42, p = 0.2219). LD measurements successfully obtained from all patients were not significantly higher in cirrhotics (0.102 ± 0.0099 a.u.) compared with HVs (0.080 ± 0.0063 a.u., P = 0.0847). CONCLUSION Cardiac-induced LD is a conceptually reasonable approach from preclinical studies, measurements demonstrate good reproducibility and inter-reader variability, are less likely to be affected by hepatic hemodynamic changes and are feasible in patients with cirrhosis.
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Affiliation(s)
- Manil D Chouhan
- Division of Medicine, Centre for Medical Imaging, University College London (UCL), London, UK.
| | - Heather E Fitzke
- Division of Medicine, Centre for Medical Imaging, University College London (UCL), London, UK
- Wingate Institute of Neurogastroenterology, Neuroscience and Trauma, Queen Mary University of London (QMUL), London, UK
| | - Alan Bainbridge
- Department of Medical Physics, University College London Hospitals NHS Trust, London, UK
| | - David Atkinson
- Division of Medicine, Centre for Medical Imaging, University College London (UCL), London, UK
| | - Steve Halligan
- Division of Medicine, Centre for Medical Imaging, University College London (UCL), London, UK
| | - Nathan Davies
- Division of Medicine, Institute for Liver and Digestive Health, University College London (UCL), London, UK
| | - Mark F Lythgoe
- Division of Medicine, Centre for Advanced Biomedical Imaging, University College London (UCL), London, UK
| | - Rajeshwar P Mookerjee
- Division of Medicine, Institute for Liver and Digestive Health, University College London (UCL), London, UK
| | - Alex Menys
- Division of Medicine, Centre for Medical Imaging, University College London (UCL), London, UK
- Motilent, London, UK
| | - Stuart A Taylor
- Division of Medicine, Centre for Medical Imaging, University College London (UCL), London, UK
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14
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Noninvasive diagnosis of portal hypertension using gadoxetate DCE-MRI of the liver and spleen. Eur Radiol 2021; 31:4804-4812. [PMID: 33411050 DOI: 10.1007/s00330-020-07495-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/25/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To assess the performance of gadoxetate dynamic contrast-enhanced (DCE) MRI of the liver and spleen for noninvasive diagnosis of portal hypertension (PH). METHODS Thirty-five patients (M/F 22/13, mean age 55 years) with chronic liver disease who underwent hepatic venous pressure gradient (HVPG) measurements were prospectively enrolled in this IRB-approved study. All patients underwent multiparametric MRI including gadoxetate DCE-MRI acquisition. Model-based and model-free DCE-MRI analyses were performed. The correlation between DCE-MRI parameters and HVPG was assessed. ROC analysis was employed to determine the diagnostic performance of DCE-MRI parameters alone and in combination for prediction of PH and clinically significant (CS)PH (HVPG > 5 and ≥ 10 mmHg, respectively). RESULTS Mean HVPG was 7.0 ± 5.0 mmHg (range 0-18 mmHg). Twenty-one (60%) patients had PH, of whom 9 had CSPH. Modeled liver uptake fraction fi and uptake rate ki and model-free parameters liver upslope and uptake were all significantly negatively correlated with HVPG (r range - 0.490 to - 0.398, p value range 0.003-0.018), while spleen interstitial fraction ve was significantly positively correlated with HVPG (r = 0.336, p = 0.048). For PH diagnosis, liver ki showed the best diagnostic performance with an AUC, sensitivity, and specificity of 0.74 (confidence interval (CI) 0.57-0.91), 71.4%, and 78.6%. The combination of liver ki and spleen ve was selected as the best classifier for diagnosis of CSPH with an AUC, sensitivity, and specificity of 0.87 (CI 0.75-0.99), 100%, and 73.1%. CONCLUSIONS Our results demonstrate the potential utility of hepatocyte uptake parameters and spleen interstitial fraction obtained with gadoxetate DCE-MRI for the diagnosis of PH and CSPH. KEY POINTS • Liver uptake and spleen interstitial fraction estimates from gadoxetate DCE-MRI are significantly correlated with portal pressure measurements. • Liver uptake rate shows good diagnostic performance for the diagnosis of portal hypertension. • The combination of liver uptake rate with spleen interstitial fraction exhibits excellent diagnostic performance for the diagnosis of clinically significant portal hypertension.
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15
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Manduca A, Bayly PJ, Ehman RL, Kolipaka A, Royston TJ, Sack I, Sinkus R, Van Beers BE. MR elastography: Principles, guidelines, and terminology. Magn Reson Med 2020; 85:2377-2390. [PMID: 33296103 DOI: 10.1002/mrm.28627] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/20/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022]
Abstract
Magnetic resonance elastography (MRE) is a phase contrast-based MRI technique that can measure displacement due to propagating mechanical waves, from which material properties such as shear modulus can be calculated. Magnetic resonance elastography can be thought of as quantitative, noninvasive palpation. It is increasing in clinical importance, has become widespread in the diagnosis and staging of liver fibrosis, and additional clinical applications are being explored. However, publications have reported MRE results using many different parameters, acquisition techniques, processing methods, and varied nomenclature. The diversity of terminology can lead to confusion (particularly among clinicians) about the meaning of and interpretation of MRE results. This paper was written by the MRE Guidelines Committee, a group formalized at the first meeting of the ISMRM MRE Study Group, to clarify and move toward standardization of MRE nomenclature. The purpose of this paper is to (1) explain MRE terminology and concepts to those not familiar with them, (2) define "good practices" for practitioners of MRE, and (3) identify opportunities to standardize terminology, to avoid confusion.
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Affiliation(s)
- Armando Manduca
- Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Philip J Bayly
- Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Richard L Ehman
- Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Arunark Kolipaka
- Department of Radiology, Ohio State University, Columbus, Ohio, USA
| | - Thomas J Royston
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ingolf Sack
- Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ralph Sinkus
- Imaging Sciences & Biomedical Engineering, Kings College London, London, United Kingdom
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16
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Kennedy P, Bane O, Hectors SJ, Fischman A, Schiano T, Lewis S, Taouli B. Noninvasive imaging assessment of portal hypertension. Abdom Radiol (NY) 2020; 45:3473-3495. [PMID: 32926209 PMCID: PMC10124623 DOI: 10.1007/s00261-020-02729-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/16/2020] [Accepted: 08/30/2020] [Indexed: 02/07/2023]
Abstract
Portal hypertension (PH) is a spectrum of complications of chronic liver disease (CLD) and cirrhosis, with manifestations including ascites, gastroesophageal varices, splenomegaly, hypersplenism, hepatic hydrothorax, hepatorenal syndrome, hepatopulmonary syndrome and portopulmonary hypertension. PH can vary in severity and is diagnosed via invasive hepatic venous pressure gradient measurement (HVPG), which is considered the reference standard. Accurate diagnosis of PH and assessment of severity are highly relevant as patients with clinically significant portal hypertension (CSPH) are at higher risk for developing acute variceal bleeding and mortality. In this review, we discuss current and upcoming noninvasive imaging methods for diagnosis and assessment of severity of PH.
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17
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Abstract
Perfusion imaging allows for the quantitative extraction of physiological perfusion parameters of the liver microcirculation at levels far below the spatial the resolution of CT and MR imaging. Because of its peculiar structure and architecture, perfusion imaging is more challenging in the liver than in other organs. Indeed, the liver is a mobile organ and significantly deforms with respiratory motion. Moreover, it has a dual vascular supply and the sinusoidal capillaries are fenestrated in the normal liver. Using extracellular contrast agents, perfusion imaging has shown its ability to discriminate patients with various stages of liver fibrosis. The recent introduction of hepatobiliary contrast agents enables quantification of both the liver perfusion and the hepatocyte transport function using advanced perfusion models. The purpose of this review article is to describe the characteristics of liver perfusion imaging to assess chronic liver disease, with a special focus on CT and MR imaging.
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18
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Li J, Sehrawat TS, Chen J, Hilscher MB, Glaser KJ, Arab JP, De Assuncao TM, Simonetto DA, Mounajjed T, Manduca A, Ehman RL, Shah VH, Yin M. Quantitative assessment of portal hypertension with bi-parametric dual-frequency hepatic MR elastography in mouse models. Eur Radiol 2020; 31:2303-2311. [PMID: 33026502 DOI: 10.1007/s00330-020-07341-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/28/2020] [Accepted: 09/22/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To determine the potential of bi-parametric dual-frequency hepatic MR elastography (MRE) for predicting portal pressure (PP) in mouse models of portal hypertension (PHTN) with the presence of varying hepatic fibrosis. METHODS We studied 73 wild-type male mice, including 22 mice with hepatic congestion, 20 mice with cholestatic liver injury, and 31 age-matched sham mice. Hepatic shear stiffness (SS) and volumetric strain (VS) were calculated by 3D MRE acquired at 80 and 200 Hz. We measured PP immediately after MRE. Liver fibrosis was verified by hydroxyproline assay. We predicted PP by fitting generalized linear models with single- and dual-frequency SS and VS, respectively. The relationship between predicted and actual PP was evaluated by Spearman's correlation. We compared the prediction accuracy of portal hypertension for all models with DeLong tests at a significance level of 0.05. RESULTS Animals with congestive or cholestatic liver disease developed significant PHTN and hepatic fibrosis to varying degrees. In both models, SS increased, while VS decreased significantly compared with shams. All bi-parametric models had high diagnostic accuracy for PHTN. The dual-frequency models (AUCs: 0.90 [81-95%], 0.91 [81-95%]) had substantially or significantly higher accuracy than single-frequency ones (AUCs: 0.83 [71-91%], and 0.78 [66-87%]). The predicted PP of dual-frequency models also showed stronger correlations with actual PP than single-frequency predictions. CONCLUSIONS The bi-parametric dual-frequency model improved the diagnostic accuracy of liver MRE in diagnosing PHTN in preclinical models. This technical advance has the potential to monitor PHTN progression and treatment efficacy in the presence of varying fibrosis. KEY POINTS • Bi-parametric hepatic MR elastography can predict portal pressure. • The prediction models of shear stiffness and volumetric strain with dual-frequency measurements demonstrate high diagnostic accuracy (AUCs > 0.9) in two different portal hypertension mouse models with varying fibrosis.
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Affiliation(s)
- Jiahui Li
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Tejasav S Sehrawat
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Jingbiao Chen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Moira B Hilscher
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Kevin J Glaser
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Juan P Arab
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | | | - Douglas A Simonetto
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | | | - Armando Manduca
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | | | - Vijay H Shah
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Meng Yin
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
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19
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Jiang J, Li J, Chu Z, Tao Z, Cai W, Zhu J, Grimm R, Ji Q. In vivo multiparametric magnetic resonance imaging study for differentiating the severity of hepatic warm ischemia-reperfusion injury in a rabbit model. Magn Reson Imaging 2020; 74:105-112. [PMID: 32931888 DOI: 10.1016/j.mri.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 08/07/2020] [Accepted: 09/08/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To assess the value of multiparametric magnetic resonance imaging including intravoxel incoherent motion (IVIM), diffusion tensor imaging (DTI) and blood oxygen level dependent (BOLD) MRI in differentiating the severity of hepatic warm ischemia-reperfusion injury (WIRI) in a rabbit model. METHODS Fifty rabbits were randomly divided into a sham-operation group and four test groups (n = 10 for each group) according to different hepatic warm ischemia times. IVIM, DTI and BOLD MRI were performed on a 3 T MR scanner with 11 b values (0 to 800 s/mm2), 2 b values (0 and 500 s/mm2) on 12 diffusion directions, multiple-echo gradient echo (GRE) sequences (TR/TE, 75/2.57-24.25 ms), respectively. IVIM, DTI and BOLD MRI parameters, hepatic biochemical and histopathological parameters were compared. Pearson and Spearman correlation methods were performed to assess the correlation between these MRI parameters and laboratory parameters. Furthermore, receiver operating characteristic (ROC) curves were compiled to determine diagnostic efficacies. RESULTS True diffusion (Dslow), pseudodiffusion (Dfast), perfusion fraction (PF), mean diffusivity (MD) significantly decreased, while R2* significantly increased with prolonged warm ischemia times, and significant differences were found in all of biochemical and histopathological parameters (all P < 0.05). Dslow, PF, and R2* correlated significantly with all of biochemical and histopathological parameters (all |r| = 0.381-0.746, all P < 0.05). ROC analysis showed that the area under the ROC curve (AUC) of IVIM across hepatic WIRI groups was the largest among IVIM, DTI and BOLD. CONCLUSIONS Multiparametric MRI may be helpful with characterization of early changes and determination of severity of hepatic WIRI in a rabbit model.
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Affiliation(s)
- Jiabing Jiang
- First Central Clinical College of Tianjin Medical University, 24 Fukang Road, Nankai District, Tianjin, China; Department of Radiology, Tianjin First Central Hospital, 24 Fukang Road, Nankai District, Tianjin, China
| | - Jingyao Li
- First Central Clinical College of Tianjin Medical University, 24 Fukang Road, Nankai District, Tianjin, China; Department of Radiology, Tianjin First Central Hospital, 24 Fukang Road, Nankai District, Tianjin, China
| | - Zhiqiang Chu
- Department of Transplantation, Tianjin First Central Hospital, 24 Fukang Road, Nankai District, Tianjin, China
| | - Zhengzheng Tao
- First Central Clinical College of Tianjin Medical University, 24 Fukang Road, Nankai District, Tianjin, China; Department of Radiology, Tianjin First Central Hospital, 24 Fukang Road, Nankai District, Tianjin, China
| | - Wenjuan Cai
- Department of Pathology, Tianjin First Central Hospital, 24 Fukang Road, Nankai District, Tianjin, China
| | - Jinxia Zhu
- Siemens Healthcare, MR Collaborations PA, Beijing, China
| | | | - Qian Ji
- Department of Radiology, Tianjin First Central Hospital, 24 Fukang Road, Nankai District, Tianjin, China.
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20
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Hectors SJ, Bane O, Stocker D, Carbonell G, Lewis S, Kennedy P, Schiano TD, Thung S, Fischman A, Taouli B. Splenic T 1ρ as a noninvasive biomarker for portal hypertension. J Magn Reson Imaging 2020; 52:787-794. [PMID: 32073207 DOI: 10.1002/jmri.27087] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There is a need for noninvasive methods for the diagnosis and monitoring of portal hypertension (PH). PURPOSE To 1) assess the correlation of liver and spleen T1 and T1ρ measurements with portal pressures in patients with chronic liver disease, and 2) to compare the diagnostic performance of the relaxation parameters with radiological assessment of PH. STUDY TYPE Prospective. SUBJECTS Twenty-five patients (M/F 16/9, mean age 56 years, range 21-78 years) undergoing portal pressure (hepatic venous pressure gradient [HVPG]) measurements. FIELD STRENGTH/SEQUENCE 1.5T abdominal MRI scan, including T1ρ and T1 mapping. ASSESSMENT Liver and spleen T1ρ and T1 , radiological PH score, and (normalized) spleen length were evaluated. STATISTICAL TESTS Spearman correlation of all MRI parameters with HVPG was assessed. The diagnostic performance of the assessed parameters for prediction of PH (HVPG ≥5 mmHg) and clinically significant PH (CSPH, HVPG ≥10 mmHg) was determined by receiver operating characteristic (ROC) analysis. RESULTS The mean HVPG measurement was 7.8 ± 5.3 mmHg (PH, n = 18 [72%] including CSPH, n = 9 [36%]). PH score, (normalized) spleen length and spleen T1ρ significantly correlated with HVPG, with the strongest correlation found for spleen T1ρ (r = 0.613, P = 0.001). Spleen T1ρ was the only parameter that showed significant diagnostic performance for assessment of PH (area under the curve [AUC] 0.817, P = 0.015) and CSPH (AUC = 0.778, P = 0.024). Normalized spleen length also showed significant diagnostic performance for prediction of CSPH, with a slightly lower AUC (= 0.764, P = 0.031). The radiological PH score, T1ρ and T1 of the liver and T1 of the spleen, did not show significant diagnostic performance for assessment of CSPH (P > 0.075). DATA CONCLUSION Spleen T1ρ showed a significant correlation with portal pressure and showed improved diagnostic performance for prediction of CSPH compared to radiological assessment. These initial results need confirmation in a larger cohort. LEVEL OF EVIDENCE 1 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2020;52:787-794.
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Affiliation(s)
- Stefanie J Hectors
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Octavia Bane
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel Stocker
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Institute of Interventional and Diagnostic Radiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Guillermo Carbonell
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Radiology, Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain
| | - Sara Lewis
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Paul Kennedy
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thomas D Schiano
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Swan Thung
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Aaron Fischman
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bachir Taouli
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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21
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Keller S, Chapiro J, Brangsch J, Reimann C, Collettini F, Sack I, Savic LJ, Hamm B, Goldberg SN, Makowski M. Quantitative MRI for Assessment of Treatment Outcomes in a Rabbit VX2 Hepatic Tumor Model. J Magn Reson Imaging 2019; 52:668-685. [PMID: 31713973 DOI: 10.1002/jmri.26968] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 12/24/2022] Open
Abstract
Globally, primary and secondary liver cancer is one of the most common cancer types, accounting 8.2% of deaths worldwide in 2018. One of the key strategies to improve the patient's prognosis is the early diagnosis, when liver function is still preserved. In hepatocellular carcinoma (HCC), the typical wash-in/wash-out pattern in conventional magnetic resonance imaging (MRI) reaches a sensitivity of 60% and specificity of 96-100%. However, in recent years functional MRI sequences such as hepatocellular-specific gadolinium-based dynamic-contrast enhanced MRI, diffusion-weighted imaging (DWI), and magnetic resonance spectroscopy (MRS) have been demonstrated to improve the evaluation of treatment success and thus the therapeutic decision-making and the patient's outcome. In the preclinical research setting, the VX2 liver rabbit tumor, which once originated from a virus-induced anaplastic squamous cell carcinoma, has played a longstanding role in experimental interventional oncology. Especially the high tumor vascularity allows assessing the treatment response of locoregional interventions such as radiofrequency ablation (RFA) and transcatheter arterial embolization (TACE). Functional MRI has been used to monitor the tumor growth and viability following interventional treatment. Besides promising results, a comprehensive overview of functional MRI sequences used so far in different treatment setting is lacking, thus lowering the comparability of study results. This review offers a comprehensive overview of study protocols, results, and limitations of quantitative MRI sequences applied to evaluate the treatment outcome of VX2 hepatic tumor models, thus generating a unique basis for future MRI studies and potential translation into the clinical setting. Level of Evidence: 2 Technical Efficacy: Stage 1 J. MAGN. RESON. IMAGING 2019. J. Magn. Reson. Imaging 2020;52:668-685.
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Affiliation(s)
- Sarah Keller
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Julius Chapiro
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Julia Brangsch
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Carolin Reimann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Federico Collettini
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ingolf Sack
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lynn Jeanette Savic
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Shraga Nahum Goldberg
- Department of Radiology, Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Marcus Makowski
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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22
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Guglielmo FF, Venkatesh SK, Mitchell DG. Liver MR Elastography Technique and Image Interpretation: Pearls and Pitfalls. Radiographics 2019; 39:1983-2002. [DOI: 10.1148/rg.2019190034] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Flavius F. Guglielmo
- From the Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (F.F.G., D.G.M.); and Department of Radiology, Mayo Clinic, Rochester, Minn (S.K.V.)
| | - Sudhakar K. Venkatesh
- From the Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (F.F.G., D.G.M.); and Department of Radiology, Mayo Clinic, Rochester, Minn (S.K.V.)
| | - Donald G. Mitchell
- From the Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (F.F.G., D.G.M.); and Department of Radiology, Mayo Clinic, Rochester, Minn (S.K.V.)
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23
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Sauer F, Oswald L, Ariza de Schellenberger A, Tzschätzsch H, Schrank F, Fischer T, Braun J, Mierke CT, Valiullin R, Sack I, Käs JA. Collagen networks determine viscoelastic properties of connective tissues yet do not hinder diffusion of the aqueous solvent. SOFT MATTER 2019; 15:3055-3064. [PMID: 30912548 DOI: 10.1039/c8sm02264j] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Collagen accounts for the major extracellular matrix (ECM) component in many tissues and provides mechanical support for cells. Magnetic Resonance (MR) Imaging, MR based diffusion measurements and MR Elastography (MRE) are considered sensitive to the microstructure of tissues including collagen networks of the ECM. However, little is known whether water diffusion interacts with viscoelastic properties of tissues. This study combines highfield MR based diffusion measurements, novel compact tabletop MRE and confocal microscopy in collagen networks of different cross-linking states (untreated collagen gels versus additional treatment with glutaraldehyde). The consistency of bulk rheology and MRE within a wide dynamic range is demonstrated in heparin gels, a viscoelastic standard for MRE. Additional crosslinking of collagen led to an 8-fold increased storage modulus, a 4-fold increased loss modulus and a significantly decreased power law exponent, describing multi-relaxational behavior, corresponding to a pronounced transition from viscous-soft to elastic-rigid properties. Collagen network changes were not detectable by MR based diffusion measurements and microscopy which are sensitive to the micrometer scale. The MRE-measured shear modulus is sensitive to collagen fiber interactions which take place on the intrafiber level such as fiber stiffness. The insensitivity of MR based diffusion measurements to collagen hydrogels of different cross-linking states alludes that congeneric collagen structures in connective tissues do not hinder extracellular diffusive water transport. Furthermore, the glutaraldehyde induced rigorous changes in viscoelastic properties indicate that intrafibrillar dissipation is the dominant mode of viscous dissipation in collagen-dominated connective tissue.
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Affiliation(s)
- Frank Sauer
- Soft Matter Physics Division, Peter Debye Institute for Soft Matter Physics, Linnestr. 5, Leipzig, Germany.
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24
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Do regions of interest location and type influence liver stiffness measurement using magnetic resonance elastography? Diagn Interv Imaging 2019; 100:363-370. [PMID: 30745249 DOI: 10.1016/j.diii.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE To assess the variability of liver stiffness measurements using magnetic resonance elastography (MRE) at 1.5T, depending on different approaches of regions of interest (ROIs) drawing. MATERIAL AND METHODS Fifty consecutive patients with successful liver MRE were included. There were 32 men and 18 women with a mean age of 52±14 (SD) years (range: 20-85 years). MRE was acquired using a gradient recalled-echo MRE sequence. At the level of the portal bifurcation, one observer drawn in the right liver first 3 elliptical ROI and then one free-hand ROI, as large as possible based on the confidence map and the anatomy. Three additional elliptical ROIs were further drawn on the slice above and 3 other on the slice below, for a total of 9 elliptical ROIs. The average value of liver stiffness in the 3 elliptical ROIs of the central slice and the one from the 9 elliptical ROIs were computed. Three liver stiffness values were obtained for each patient from the 3 measurement methods (one free-hand ROI, 3 elliptical ROIs and 9 elliptical ROIs). Inter-method variability was assessed using the intra-class correlation coefficient (ICC) and Bland-Altman analysis. RESULTS The variability between the 3 methods was excellent with ICC>0.978 (P<0.0001). The Bland-Altman analysis revealed high agreement between the 3 methods with bias<0.45kPa and limits of agreement<±1.13kPa. The variability was lower when comparing a large free-hand ROI and the 3-elliptical ROIs, than when comparing the 9-elliptical ROIs to one of the other methods. CONCLUSION Our results show that the variability between the 3 methods of ROI drawing and placement is very low.
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25
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Cox EF, Palaniyappan N, Aithal GP, Guha IN, Francis ST. Using MRI to study the alterations in liver blood flow, perfusion, and oxygenation in response to physiological stress challenges: Meal, hyperoxia, and hypercapnia. J Magn Reson Imaging 2018; 49:1577-1586. [PMID: 30353969 DOI: 10.1002/jmri.26341] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/29/2018] [Accepted: 08/29/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Noninvasive assessment of dynamic changes in liver blood flow, perfusion, and oxygenation using MRI may allow detection of subtle hemodynamic alterations in cirrhosis. PURPOSE To assess the feasibility of measuring dynamic liver blood flow, perfusion, and T2 * alterations in response to meal, hypercapnia, and hyperoxia challenges. STUDY TYPE Prospective. SUBJECTS Ten healthy volunteers (HV) and 10 patients with compensated cirrhosis (CC). FIELD STRENGTH/SEQUENCE 3T; phase contrast, arterial spin labeling, and T 2 * mapping. ASSESSMENT Dynamic changes in portal vein and hepatic artery blood flow (using phase contrast MRI), liver perfusion (using arterial spin labeling), and blood oxygenation ( T 2 * mapping) following a meal challenge (660 kcal), hyperoxia (target PET O2 of 500 mmHg), and hypercapnia (target increase PET CO2 of ∼6 mmHg). STATISTICAL TESTS Tests between baseline and each challenge were performed using a paired two-tailed t-test (parametric) or Wilcoxon-signed-ranks test (nonparametric). Repeatability and reproducibility were determined by the coefficient of variation (CoV). RESULTS Portal vein velocity increased following the meal (70 ± 9%, P < 0.001) and hypercapnic (7 (5-11)%, P = 0.029) challenge, while hepatic artery flow decreased (-30 ± 18%, P = 0.005) following the meal challenge in HV. In CC patients, portal vein velocity increased (37 ± 13%, P = 0.012) without the decrease in hepatic artery flow following the meal. In both groups, the meal increased liver perfusion (HV: 82 ± 50%, P < 0.0001; CC: 27 (16-42)%, P = 0.011) with faster arrival time of blood (HV: -54 (-56-30)%, P = 0.074; CC: -42 ± 32%, P = 0.005). In HVs, T 2 * increased after the meal and in response to hyperoxia, with a decrease in hypercapnia (6 ± 8% P = 0.052; 3 ± 5%, P = 0.075; -5 ± 6%, P = 0.073, respectively), but no change in CC patients. Baseline between-session CoV <15% for blood flow and <10% for T 2 * measures. DATA CONCLUSION Dynamic changes in liver perfusion, blood flow, and oxygenation following a meal, hyperoxic, and hypercapnic challenges can be measured using noninvasive MRI and potentially be used to stratify patients with cirrhosis. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:1577-1586.
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Affiliation(s)
- Eleanor F Cox
- Sir Peter Mansfield Imaging Centre, School of Physics & Astronomy, University of Nottingham, Nottingham, UK
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Naaventhan Palaniyappan
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Guruprasad P Aithal
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - I Neil Guha
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Susan T Francis
- Sir Peter Mansfield Imaging Centre, School of Physics & Astronomy, University of Nottingham, Nottingham, UK
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
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26
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Multiparametric FDG-PET/MRI of Hepatocellular Carcinoma: Initial Experience. CONTRAST MEDIA & MOLECULAR IMAGING 2018; 2018:5638283. [PMID: 30402045 PMCID: PMC6192124 DOI: 10.1155/2018/5638283] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/30/2018] [Accepted: 09/06/2018] [Indexed: 12/16/2022]
Abstract
Purpose To compare multiparametric (mp)FDG-PET/MRI metrics between hepatocellular carcinoma (HCC) and liver parenchyma and to assess the correlation between mpMRI and FDG-PET standard uptake values (SUVs) in liver parenchyma and HCC. Methods This prospective, institutional review board-approved study enrolled 15 patients (M/F 12/3; mean age 61 y) with HCC. mpMRI including blood-oxygen-level-dependent (BOLD) MRI, intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI), and dynamic contrast-enhanced-(DCE-) MRI was performed simultaneously with 18F-FDG-PET on a 3T PET/MRI hybrid system. Quantitative BOLD, IVIM and DCE-MRI parameters (Tofts model (TM) and shutter-speed model (SSM)), and PET parameters (SUVmean and SUVmax) were quantified and compared between HCC lesions and liver parenchyma using Wilcoxon signed-rank tests. SUV ratios between HCCs and liver were also calculated (SUVmean T/L and SUVmax T/L). Diagnostic performance of (combined) mp-PET/MRI parameters for characterization of HCC was assessed using ROC analysis. Spearman correlations between PET and mpMRI parameters in HCC tumors and liver parenchyma were evaluated. Results 21 HCC lesions (mean size 4.0 ± 2.4 cm; range 2-13 cm) were analyzed. HCCs exhibited significantly higher arterial fraction (from DCE-MRI) and lower R 2 ∗ pre-O2 and post-O2 (from BOLD-MRI) versus liver parenchyma (P < 0.032). The highest diagnostic performance for differentiation between HCC and liver parenchyma was achieved for combined ART SSM and R 2 ∗ post-O2 (AUC = 0.91). SUVmax showed reasonable performance for differentiation of HCC versus liver (AUC = 0.75). In HCC, DCE-MRI parameters K trans (TM and SSM) and v e TM exhibited significant negative correlations with SUVmax T/L (r ranges from -0.624 to -0.566; FDR-adjusted P < 0.050). Conclusions Despite the observed reasonable diagnostic performance of FDG-PET SUVmax for HCC detection and several significant correlations between FDG-PET SUV and DCE-MRI parameters, FDG-PET did not provide clear additional value for HCC characterization compared to mpMRI in this pilot study.
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Chevallier O, Zhou N, He J, Loffroy R, Wáng YXJ. Removal of evidential motion-contaminated and poorly fitted image data improves IVIM diffusion MRI parameter scan-rescan reproducibility. Acta Radiol 2018; 59:1157-1167. [PMID: 29430937 DOI: 10.1177/0284185118756949] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background It has been reported that intravoxel incoherent motion (IVIM) diffusion magnetic resonance imaging (MRI) scan-rescan reproducibility is unsatisfactory. Purpose To study IVIM MRI parameter reproducibility for liver parenchyma after the removal of motion-contaminated and/or poorly fitted image data. Material and Methods Eighteen healthy volunteers had liver scans twice in the same session to assess scan-rescan repeatability, and again in another session after an average interval of 13 days to assess reproducibility. Diffusion-weighted images were acquired with a 3-T scanner using respiratory-triggered echo-planar sequence and 16 b-values (0-800 s/mm2). Measurement was performed on the right liver with segment-unconstrained least square fitting. Image series with evidential anatomical mismatch, apparent artifacts, and poorly fitted signal intensity vs. b-value curve were excluded. A minimum of three slices was deemed necessary for IVIM parameter estimation. Results With a total 54 examinations, six did not satisfy inclusion criteria, leading to a success rate of 89%, and 14 volunteers were finally included for the repeatability/reproducibility study. A total of 3-10 slices per examination (mean = 5.3 slices, median = 5 slices) were utilized for analysis. Using threshold b-value = 80 s/mm2, the coefficient of variation and within-subject coefficient of variation for repeatability were 2.86% and 3.36% for Dslow, 3.81% and 4.24% for perfusion fraction (PF), 18.16% and 24.88% for Dfast; and those for reproducibility were 2.48% and 3.24% for Dslow, 4.91% and 5.38% for PF, and 21.18% and 30.89% for Dfast. Conclusion Removal of motion-contaminated and/or poorly fitted image data improves IVIM parameter reproducibility.
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Affiliation(s)
- Olivier Chevallier
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong SAR
- Department of Vascular and Interventional Radiology, University of Bourgogne/Franche-Comté, François-Mitterrand Teaching Hospital, Dijon Cedex, France
| | - Nan Zhou
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, PR China
| | - Jian He
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, PR China
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, University of Bourgogne/Franche-Comté, François-Mitterrand Teaching Hospital, Dijon Cedex, France
| | - Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong SAR
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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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Cox EF, Palaniyappan N, Aithal GP, Guha IN, Francis ST. MRI assessment of altered dynamic changes in liver haemodynamics following a meal challenge in compensated cirrhosis. Eur Radiol Exp 2018. [PMCID: PMC6156698 DOI: 10.1186/s41747-018-0056-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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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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Venkatesh SK, Wells ML, Miller FH, Jhaveri KS, Silva AC, Taouli B, Ehman RL. Magnetic resonance elastography: beyond liver fibrosis-a case-based pictorial review. Abdom Radiol (NY) 2018; 43:1590-1611. [PMID: 29143076 PMCID: PMC6731769 DOI: 10.1007/s00261-017-1383-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Magnetic resonance elastography (MRE) has been introduced for clinical evaluation of liver fibrosis for nearly a decade. MRE has proven to be a robust and accurate technique for diagnosis and staging of liver fibrosis. As clinical experience with MRE grows, the possible role in evaluation of other diffuse and focal disorders of liver is emerging. Stiffness maps provide an opportunity to evaluate mechanical properties within a large volume of liver tissue. This enables appreciation of spatial heterogeneity of stiffness. Stiffness maps may reveal characteristic and differentiating features of chronic liver diseases and focal liver lesions and therefore provide useful information for clinical management. The objective of this pictorial review is to recapture the essentials of MRE technique and illustrate with examples, the utility of stiffness maps in other chronic liver disorders and focal liver lesions.
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Affiliation(s)
- Sudhakar K Venkatesh
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200, First Street SW, Rochester, MN, 55905, USA.
| | - Michael L Wells
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200, First Street SW, Rochester, MN, 55905, USA
| | - Frank H Miller
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Kartik S Jhaveri
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Alvin C Silva
- Department of Radiology, Mayo Clinic, Scottsdale, AZ, USA
| | - Bachir Taouli
- NYU Medical College, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Richard L Ehman
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200, First Street SW, Rochester, MN, 55905, USA
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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: 185] [Impact Index Per Article: 30.8] [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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Ji Q, Chu ZQ, Ren T, Xu SC, Zhang LJ, Shen W, Lu GM. Multiparametric functional magnetic resonance imaging for evaluation of hepatic warm ischemia-reperfusion injury in a rabbit model. BMC Gastroenterol 2017; 17:161. [PMID: 29246201 PMCID: PMC5732447 DOI: 10.1186/s12876-017-0720-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 11/29/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND To assess the feasibility of noninvasive and quantitative evaluation of hepatic pathophysiological changes in rabbit hepatic warm ischemia-reperfusion injury (WIRI) models by using intravoxel incoherent motion (IVIM), diffusion tensor imaging (DTI) and blood oxygen level dependent (BOLD) MRI. METHODS Twenty rabbits were randomly divided into hepatic WIRI model group and sham-operation group (n = 10 for each group). Hepatic WIRI was induced in rabbit by occluding hepatic inflow for 30 min and reperfusion for 6 h. The control group only underwent laparotomy and liver ligament dissection. IVIM with 11 b values (0 to 800 s/mm2), DTI with 2 b values (0 and 500 s/mm2) on 12 diffusion directions, and BOLD MRI with 9 TE (2.57 to 24.25 ms) were performed at 3 T clinical MR scanner. Rabbits were sacrificed for biochemical and histopathological analysis after MR scanning. All of functional MR, biochemical and histopathological parameters were analyzed by independent sample t test, Mann-Whitney U test, Pearson and Spearman correlation methods. RESULTS All of MR parameters showed moderate to excellent interobserver reproducibility. True diffusion (Dslow), pseudodiffusion (Dfast), perfusion fraction (PF), and mean diffusitivity (MD) were lower in WIRI models than in control rabbits (P < 0.01), R2* was higher in WIRI models than in control rabbits (P < 0.001), while fractional anisotropy (FA) showed no statistical difference. There were significant differences in I score and all of biochemical parameters between the two groups (P < 0.01). Functional MR parameters corresponded well with all of biochemical parameters and some of histopathological parameters (P < 0.05). Histopathological analysis showed the structure and morphology of hepatic lobule was normal and clear in control rabbits, while diffuse hepatocyte swelling, central vein and sinusoids congestion, and inflammatory cell infiltration in WIRI models. CONCLUSIONS IVIM, DTI, and BOLD MRI are noninvasive and useful techniques for assessing the microenvironment changes of hepatic WIRI in rabbit models.
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Affiliation(s)
- Qian Ji
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, China.,Department of Radiology, Tianjin First Central Hospital, 24 Fukang Road, Nankai District, Tianjin, China
| | - Zhi Qiang Chu
- Department of Transplantation, Tianjin First Central Hospital, 24 Fukang Road, Nankai District, Tianjin, China
| | - Tao Ren
- Department of Radiology, Tianjin First Central Hospital, 24 Fukang Road, Nankai District, Tianjin, China
| | - Shi Chao Xu
- Department of Transplantation, Tianjin First Central Hospital, 24 Fukang Road, Nankai District, Tianjin, China
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, China
| | - Wen Shen
- Department of Radiology, Tianjin First Central Hospital, 24 Fukang Road, Nankai District, Tianjin, China.
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, China.
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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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Horowitz JM, Venkatesh SK, Ehman RL, Jhaveri K, Kamath P, Ohliger MA, Samir AE, Silva AC, Taouli B, Torbenson MS, Wells ML, Yeh B, Miller FH. Evaluation of hepatic fibrosis: a review from the society of abdominal radiology disease focus panel. Abdom Radiol (NY) 2017. [PMID: 28624924 DOI: 10.1007/s00261-017-1211-7] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hepatic fibrosis is potentially reversible; however early diagnosis is necessary for treatment in order to halt progression to cirrhosis and development of complications including portal hypertension and hepatocellular carcinoma. Morphologic signs of cirrhosis on ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) alone are unreliable and are seen with more advanced disease. Newer imaging techniques to diagnose liver fibrosis are reliable and accurate, and include magnetic resonance elastography and US elastography (one-dimensional transient elastography and point shear wave elastography or acoustic radiation force impulse imaging). Research is ongoing with multiple other techniques for the noninvasive diagnosis of hepatic fibrosis, including MRI with diffusion-weighted imaging, hepatobiliary contrast enhancement, and perfusion; CT using perfusion, fractional extracellular space techniques, and dual-energy, contrast-enhanced US, texture analysis in multiple modalities, quantitative mapping, and direct molecular imaging probes. Efforts to advance the noninvasive imaging assessment of hepatic fibrosis will facilitate earlier diagnosis and improve patient monitoring with the goal of preventing the progression to cirrhosis and its complications.
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Affiliation(s)
- Jeanne M Horowitz
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 676 St. Clair St, Suite 800, Chicago, IL, 60611, USA.
| | - Sudhakar K Venkatesh
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Richard L Ehman
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kartik Jhaveri
- Division of Abdominal Imaging, Joint Department of Medical Imaging, University Health Network, Mt. Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Patrick Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Michael A Ohliger
- Department of Radiology and Biomedical Imaging, UCSF School of Medicine, Zuckerberg San Francisco General Hospital, 1001 Potrero Ave, San Francisco, CA, 94110, USA
| | - Anthony E Samir
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Alvin C Silva
- Department of Radiology, Mayo Clinic in Arizona, 13400 E. Shea Blvd., Scottsdale, AZ, 85259, USA
| | - Bachir Taouli
- Department of Radiology and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, Box 1234, New York, NY, 10029, USA
| | - Michael S Torbenson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Michael L Wells
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Benjamin Yeh
- Department of Radiology and Biomedical Imaging, UCSF School of Medicine, Zuckerberg San Francisco General Hospital, 1001 Potrero Ave, San Francisco, CA, 94110, USA
| | - Frank H Miller
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 676 St. Clair St, Suite 800, Chicago, IL, 60611, USA
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Ipek-Ugay S, Tzschätzsch H, Braun J, Fischer T, Sack I. Physiologic Reduction of Hepatic Venous Blood Flow by the Valsalva Maneuver Decreases Liver Stiffness. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1305-1311. [PMID: 28319252 DOI: 10.7863/ultra.16.07046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 09/09/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Liver stiffness increases after intake of food or water, suggesting that hepatic venous blood flow affects the results of elastographic measurements. This study investigated the correlation between in vivo liver stiffness and hepatic blood flow using the Valsalva maneuver for reducing intrahepatic venous blood flow. METHODS Intrahepatic changes in venous blood flow were assessed by sonography based on the pulsed wave Doppler velocity, vessel diameter assessment, and blood flow volume measurements in the portal vein and right hepatic vein. Time-harmonic elastography at 7 harmonic driving frequencies (30-60 Hz) was used to measure liver stiffness in the right liver lobe of 15 healthy volunteers. RESULTS The right hepatic vein diameter, flow volume, and peak pulsed wave velocity decreased during the Valsalva maneuver from mean ± SD values of 8.64 ± 1.85 to 6.55 ± 1.84 mm (P = .002), 0.53 ± 0.23 to 0.37 ± 0.26 L/min (P = .037), and 22.14 ± 4.87 to 17.38 ± 5.41 cm/s (P = .01), respectively. This maneuver decreased liver stiffness in all volunteers by a mean of approximately 13% from 1.71 ± 0.22 to 1.48 ± 0.22 m/s (P = .00006). CONCLUSIONS Our results demonstrate that liver stiffness is sensitive to altered venous blood flow, which is of clinical importance when using elastography for evaluation of portal hypertension. Furthermore, our results indicate that accurate measurement of liver stiffness requires standardized breathing conditions to rule out effects of changes in hepatic blood flow on elastographic findings.
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Affiliation(s)
- Selcan Ipek-Ugay
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Heiko Tzschätzsch
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jürgen Braun
- Department of Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Fischer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ingolf Sack
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Quantification of hepatocellular carcinoma heterogeneity with multiparametric magnetic resonance imaging. Sci Rep 2017; 7:2452. [PMID: 28550313 PMCID: PMC5446396 DOI: 10.1038/s41598-017-02706-z] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 04/18/2017] [Indexed: 12/12/2022] Open
Abstract
Tumour heterogeneity poses a significant challenge for treatment stratification. The goals of this study were to quantify heterogeneity in hepatocellular carcinoma (HCC) using multiparametric magnetic resonance imaging (mpMRI), and to report preliminary data correlating quantitative MRI parameters with advanced histopathology and gene expression in a patient subset. Thirty-two HCC patients with 39 HCC lesions underwent mpMRI including diffusion-weighted imaging (DWI), blood-oxygenation-level-dependent (BOLD), tissue-oxygenation-level-dependent (TOLD) and dynamic contrast-enhanced (DCE)-MRI. Histogram characteristics [central tendency (mean, median) and heterogeneity (standard deviation, kurtosis, skewness) MRI parameters] in HCC and liver parenchyma were compared using Wilcoxon signed-rank tests. Histogram data was correlated between MRI methods in all patients and with histopathology and gene expression in 14 patients. HCCs exhibited significantly higher intra-tissue heterogeneity vs. liver with all MRI methods (P < 0.030). Although central tendency parameters showed significant correlations between MRI methods and with each of histopathology and gene expression, heterogeneity parameters exhibited additional complementary correlations between BOLD and DCE-MRI and with histopathologic hypoxia marker HIF1α and gene expression of Wnt target GLUL, pharmacological target FGFR4, stemness markers EPCAM and KRT19 and immune checkpoint PDCD1. Histogram analysis combining central tendency and heterogeneity mpMRI features is promising for non-invasive HCC characterization on the imaging, histologic and genomics levels.
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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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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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40
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Dittmann F, Tzschätzsch H, Hirsch S, Barnhill E, Braun J, Sack I, Guo J. Tomoelastography of the abdomen: Tissue mechanical properties of the liver, spleen, kidney, and pancreas from single MR elastography scans at different hydration states. Magn Reson Med 2016; 78:976-983. [DOI: 10.1002/mrm.26484] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 08/17/2016] [Accepted: 09/07/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Florian Dittmann
- Department of Radiology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - Heiko Tzschätzsch
- Department of Radiology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - Sebastian Hirsch
- Department of Radiology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - Eric Barnhill
- Department of Radiology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - Jürgen Braun
- Department of Medical Informatics; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - Ingolf Sack
- Department of Radiology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - Jing Guo
- Department of Radiology; Charité - Universitätsmedizin Berlin; Berlin Germany
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Ipek-Ugay S, Tzschätzsch H, Hudert C, Marticorena Garcia SR, Fischer T, Braun J, Althoff C, Sack I. Time Harmonic Elastography Reveals Sensitivity of Liver Stiffness to Water Ingestion. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1289-1294. [PMID: 26971462 DOI: 10.1016/j.ultrasmedbio.2015.12.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/15/2015] [Accepted: 12/21/2015] [Indexed: 06/05/2023]
Abstract
The aim of the study was to test the sensitivity of liver stiffness (LS) measured by time harmonic elastography in large tissue windows to water uptake and post-prandial effects. Each subject gave written informed consent to participate in this institutional review board-approved prospective study. LS was measured by time harmonic elastography in 10 healthy volunteers pre- and post-prandially, as well as before, directly after and 2 h after drinking water. The LS-time function during water intake was measured in 14 scans over 3 h in five volunteers. LS increased by 10% (p = 0.0015) post-prandially and by 11% (p = 0.0024) after pure water ingestion, and decreased to normal values after 2 h. LS was lower after overnight fasting than after 2-h fasting (3%, p = 0.04). Over the time course, LS increased to post-water peak values 15 min after drinking 0.25 L water and remained unaffected by further ingestion of water. In conclusion, our study indicates that LS measured by time harmonic elastography represents an effective-medium property sensitive to physiologic changes in vascular load of the liver.
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Affiliation(s)
- Selcan Ipek-Ugay
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Heiko Tzschätzsch
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Hudert
- Clinic for Pediatric Endocrinology and Diabetology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Thomas Fischer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jürgen Braun
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Althoff
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ingolf Sack
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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42
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Chouhan MD, Lythgoe MF, Mookerjee RP, Taylor SA. Vascular assessment of liver disease-towards a new frontier in MRI. Br J Radiol 2016; 89:20150675. [PMID: 27115318 PMCID: PMC5124867 DOI: 10.1259/bjr.20150675] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Complex haemodynamic phenomena underpin the pathophysiology of chronic liver disease. Non-invasive MRI-based assessment of hepatic vascular parameters therefore has the potential to yield meaningful biomarkers for chronic liver disease. In this review, we provide an overview of vascular sequelae of chronic liver disease amenable to imaging evaluation and describe the current supportive evidence, strengths and the limitations of MRI methodologies, including dynamic contrast-enhanced, dynamic hepatocyte-specific contrast-enhanced, phase-contrast, arterial spin labelling and MR elastography in the assessment of hepatic vascular parameters. We review the broader challenges of quantitative hepatic vascular MRI, including the difficulties of motion artefact, complex post-processing, long acquisition times, validation and limitations of pharmacokinetic models, alongside the potential solutions that will shape the future of MRI and deliver this new frontier to the patient bedside.
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Affiliation(s)
- Manil D Chouhan
- 1 University College London (UCL) Centre for Medical Imaging, Division of Medicine, UCL, London, UK
| | - Mark F Lythgoe
- 2 University College London (UCL) Centre for Advanced Biomedical Imaging, Division of Medicine, UCL, London, UK
| | - Rajeshwar P Mookerjee
- 3 University College London (UCL) Institute for Liver and Digestive Health, Division of Medicine, UCL, London, UK
| | - Stuart A Taylor
- 1 University College London (UCL) Centre for Medical Imaging, Division of Medicine, UCL, London, UK
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43
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Chouhan MD, Mookerjee RP, Bainbridge A, Walker-Samuel S, Davies N, Halligan S, Lythgoe MF, Taylor SA. Use of Caval Subtraction 2D Phase-Contrast MR Imaging to Measure Total Liver and Hepatic Arterial Blood Flow: Preclinical Validation and Initial Clinical Translation. Radiology 2016; 280:916-23. [PMID: 27171018 PMCID: PMC5015842 DOI: 10.1148/radiol.2016151832] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Caval subtraction phase-contrast MR imaging is technically feasible and may offer a
reproducible and clinically viable method for measuring total liver blood flow and
hepatic arterial flow. Purpose To validate caval subtraction two-dimensional (2D) phase-contrast magnetic
resonance (MR) imaging measurements of total liver blood flow (TLBF) and hepatic
arterial fraction in an animal model and evaluate consistency and reproducibility
in humans. Materials and Methods Approval from the institutional ethical committee for animal care and research
ethics was obtained. Fifteen Sprague-Dawley rats underwent 2D phase-contrast MR
imaging of the portal vein (PV) and infrahepatic and suprahepatic inferior vena
cava (IVC). TLBF and hepatic arterial flow were estimated by subtracting
infrahepatic from suprahepatic IVC flow and PV flow from estimated TLBF,
respectively. Direct PV transit-time ultrasonography (US) and fluorescent
microsphere measurements of hepatic arterial fraction were the standards of
reference. Thereafter, consistency of caval subtraction phase-contrast MR
imaging–derived TLBF and hepatic arterial flow was assessed in 13
volunteers (mean age, 28.3 years ± 1.4) against directly measured
phase-contrast MR imaging PV and proper hepatic arterial inflow; reproducibility
was measured after 7 days. Bland-Altman analysis of agreement and coefficient of
variation comparisons were undertaken. Results There was good agreement between PV flow measured with phase-contrast MR imaging
and that measured with transit-time US (mean difference, −3.5 mL/min/100 g;
95% limits of agreement [LOA], ±61.3 mL/min/100 g). Hepatic arterial fraction
obtained with caval subtraction agreed well with those with fluorescent
microspheres (mean difference, 4.2%; 95% LOA, ±20.5%). Good consistency was
demonstrated between TLBF in humans measured with caval subtraction and direct
inflow phase-contrast MR imaging (mean difference, −1.3 mL/min/100 g; 95%
LOA, ±23.1 mL/min/100 g). TLBF reproducibility at 7 days was similar between
the two methods (95% LOA, ±31.6 mL/min/100 g vs ±29.6 mL/min/100 g). Conclusion Caval subtraction phase-contrast MR imaging is a simple and clinically viable
method for measuring TLBF and hepatic arterial flow. Online supplemental
material is available for this article.
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Affiliation(s)
- Manil D Chouhan
- From the University College London Centre for Medical Imaging (M.D.C., S.H., S.A.T.), Institute for Liver and Digestive Health (R.P.M., N.D.), and Centre for Advanced Biomedical Imaging (S.W.S., M.F.L.), Division of Medicine, University College London, 250 Euston Rd, 3rd Floor East, London NW1 2PG, England; and Department of Medical Physics, University College London Hospitals NHS Trust, London, England (A.B.)
| | - Rajeshwar P Mookerjee
- From the University College London Centre for Medical Imaging (M.D.C., S.H., S.A.T.), Institute for Liver and Digestive Health (R.P.M., N.D.), and Centre for Advanced Biomedical Imaging (S.W.S., M.F.L.), Division of Medicine, University College London, 250 Euston Rd, 3rd Floor East, London NW1 2PG, England; and Department of Medical Physics, University College London Hospitals NHS Trust, London, England (A.B.)
| | - Alan Bainbridge
- From the University College London Centre for Medical Imaging (M.D.C., S.H., S.A.T.), Institute for Liver and Digestive Health (R.P.M., N.D.), and Centre for Advanced Biomedical Imaging (S.W.S., M.F.L.), Division of Medicine, University College London, 250 Euston Rd, 3rd Floor East, London NW1 2PG, England; and Department of Medical Physics, University College London Hospitals NHS Trust, London, England (A.B.)
| | - Simon Walker-Samuel
- From the University College London Centre for Medical Imaging (M.D.C., S.H., S.A.T.), Institute for Liver and Digestive Health (R.P.M., N.D.), and Centre for Advanced Biomedical Imaging (S.W.S., M.F.L.), Division of Medicine, University College London, 250 Euston Rd, 3rd Floor East, London NW1 2PG, England; and Department of Medical Physics, University College London Hospitals NHS Trust, London, England (A.B.)
| | - Nathan Davies
- From the University College London Centre for Medical Imaging (M.D.C., S.H., S.A.T.), Institute for Liver and Digestive Health (R.P.M., N.D.), and Centre for Advanced Biomedical Imaging (S.W.S., M.F.L.), Division of Medicine, University College London, 250 Euston Rd, 3rd Floor East, London NW1 2PG, England; and Department of Medical Physics, University College London Hospitals NHS Trust, London, England (A.B.)
| | - Steve Halligan
- From the University College London Centre for Medical Imaging (M.D.C., S.H., S.A.T.), Institute for Liver and Digestive Health (R.P.M., N.D.), and Centre for Advanced Biomedical Imaging (S.W.S., M.F.L.), Division of Medicine, University College London, 250 Euston Rd, 3rd Floor East, London NW1 2PG, England; and Department of Medical Physics, University College London Hospitals NHS Trust, London, England (A.B.)
| | - Mark F Lythgoe
- From the University College London Centre for Medical Imaging (M.D.C., S.H., S.A.T.), Institute for Liver and Digestive Health (R.P.M., N.D.), and Centre for Advanced Biomedical Imaging (S.W.S., M.F.L.), Division of Medicine, University College London, 250 Euston Rd, 3rd Floor East, London NW1 2PG, England; and Department of Medical Physics, University College London Hospitals NHS Trust, London, England (A.B.)
| | - Stuart A Taylor
- From the University College London Centre for Medical Imaging (M.D.C., S.H., S.A.T.), Institute for Liver and Digestive Health (R.P.M., N.D.), and Centre for Advanced Biomedical Imaging (S.W.S., M.F.L.), Division of Medicine, University College London, 250 Euston Rd, 3rd Floor East, London NW1 2PG, England; and Department of Medical Physics, University College London Hospitals NHS Trust, London, England (A.B.)
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Hectors SJ, Wagner M, Besa C, Bane O, Dyvorne HA, Fiel MI, Zhu H, Donovan M, Taouli B. Intravoxel incoherent motion diffusion-weighted imaging of hepatocellular carcinoma: Is there a correlation with flow and perfusion metrics obtained with dynamic contrast-enhanced MRI? J Magn Reson Imaging 2016; 44:856-64. [PMID: 26919327 DOI: 10.1002/jmri.25194] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/28/2016] [Accepted: 01/30/2016] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To assess the correlation between intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) metrics in hepatocellular carcinoma (HCC) and liver parenchyma. MATERIALS AND METHODS Twenty-five patients with HCC (M/F 23/2, mean age 58 years) underwent abdominal MRI at 1.5 or 3.0T, including IVIM-DWI (with 16 b-values) and DCE-MRI (3D FLASH sequence, mean temporal resolution of 2.3 sec). IVIM-DWI parameters (pseudodiffusion coefficient, D*, diffusion coefficient, D, and perfusion fraction, PF) were quantified in HCC lesions and liver parenchyma using a Bayesian fitting algorithm. DCE-MRI parameters (arterial flow, Fa , portal flow, Fp , total flow, Ft , mean transit time, MTT, distribution volume, DV, and arterial fraction, ART) were quantified using a dual-input single-compartment model. Correlations between IVIM-DWI and DCE-MRI parameters were assessed using a Spearman correlation test. RESULTS Thirty-three HCC lesions (average size 5.0 ± 3.6 cm) were analyzed. D, D*, and PF were all significantly lower in HCC vs. liver (P < 0.05). Significantly higher Fa and ART and lower Fp were observed in HCC vs. liver (P < 0.001). Significant moderate to strong negative correlations were observed between ART and D* (r = -0.443, P = 0.028), ART and PF (r = -0.536, P = 0.006), ART and PFxD* (r = -0.655, P < 0.001), Fa and PF (r = 0.455, P = 0.023), and Fa and PFxD* (r = -0.475, P = 0.018) in liver parenchyma. There was no significant correlation between IVIM-DWI and DCE-MRI metrics in HCC lesions. CONCLUSION IVIM-DWI and DCE-MRI provide nonredundant information in HCC, while they correlate in liver parenchyma. These findings may be secondary to predominant portal inflow in the liver and tortuous vasculature and tissue heterogeneity in tumors. J. MAGN. RESON. IMAGING 2016;44:856-864.
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Affiliation(s)
- Stefanie J Hectors
- 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
| | - 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
| | - Octavia Bane
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hadrien A Dyvorne
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - M Isabel Fiel
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hongfa Zhu
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael Donovan
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, 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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45
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Jafar MM, Parsai A, Miquel ME. Diffusion-weighted magnetic resonance imaging in cancer: Reported apparent diffusion coefficients, in-vitro and in-vivo reproducibility. World J Radiol 2016; 8:21-49. [PMID: 26834942 PMCID: PMC4731347 DOI: 10.4329/wjr.v8.i1.21] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 11/10/2015] [Accepted: 12/07/2015] [Indexed: 02/06/2023] Open
Abstract
There is considerable disparity in the published apparent diffusion coefficient (ADC) values across different anatomies. Institutions are increasingly assessing repeatability and reproducibility of the derived ADC to determine its variation, which could potentially be used as an indicator in determining tumour aggressiveness or assessing tumour response. In this manuscript, a review of selected articles published to date in healthy extra-cranial body diffusion-weighted magnetic resonance imaging is presented, detailing reported ADC values and discussing their variation across different studies. In total 115 studies were selected including 28 for liver parenchyma, 15 for kidney (renal parenchyma), 14 for spleen, 13 for pancreatic body, 6 for gallbladder, 13 for prostate, 13 for uterus (endometrium, myometrium, cervix) and 13 for fibroglandular breast tissue. Median ADC values in selected studies were found to be 1.28 × 10(-3) mm(2)/s in liver, 1.94 × 10(-3) mm(2)/s in kidney, 1.60 × 10(-3) mm(2)/s in pancreatic body, 0.85 × 10(-3) mm(2)/s in spleen, 2.73 × 10(-3) mm(2)/s in gallbladder, 1.64 × 10(-3) mm(2)/s and 1.31 × 10(-3) mm(2)/s in prostate peripheral zone and central gland respectively (combined median value of 1.54×10(-3) mm(2)/s), 1.44 × 10(-3) mm(2)/s in endometrium, 1.53 × 10(-3) mm(2)/s in myometrium, 1.71 × 10(-3) mm(2)/s in cervix and 1.92 × 10(-3) mm(2)/s in breast. In addition, six phantom studies and thirteen in vivo studies were summarized to compare repeatability and reproducibility of the measured ADC. All selected phantom studies demonstrated lower intra-scanner and inter-scanner variation compared to in vivo studies. Based on the findings of this manuscript, it is recommended that protocols need to be optimised for the body part studied and that system-induced variability must be established using a standardized phantom in any clinical study. Reproducibility of the measured ADC must also be assessed in a volunteer population, as variations are far more significant in vivo compared with phantom studies.
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46
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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: 57] [Impact Index Per Article: 7.1] [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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47
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Yin Z, Kearney SP, Magin RL, Klatt D. Concurrent
3D
acquisition of diffusion tensor imaging and magnetic resonance elastography displacement data (
DTI‐MRE
): Theory and in vivo application. Magn Reson Med 2016; 77:273-284. [DOI: 10.1002/mrm.26121] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 12/15/2015] [Accepted: 12/17/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Ziying Yin
- Richard and Loan Hill Department of BioengineeringUniversity of Illinois at ChicagoChicago IL USA
| | - Steven P. Kearney
- Department of Mechanical and Industrial EngineeringUniversity of Illinois at ChicagoChicago IL USA
| | - Richard L. Magin
- Richard and Loan Hill Department of BioengineeringUniversity of Illinois at ChicagoChicago IL USA
| | - Dieter Klatt
- Richard and Loan Hill Department of BioengineeringUniversity of Illinois at ChicagoChicago IL USA
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48
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Stankovic Z. Four-dimensional flow magnetic resonance imaging in cirrhosis. World J Gastroenterol 2016; 22:89-102. [PMID: 26755862 PMCID: PMC4698511 DOI: 10.3748/wjg.v22.i1.89] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/08/2015] [Accepted: 10/13/2015] [Indexed: 02/06/2023] Open
Abstract
Since its introduction in the 1970’s, magnetic resonance imaging (MRI) has become a standard imaging modality. With its broad and standardized application, it is firmly established in the clinical routine and an essential element in cardiovascular and abdominal imaging. In addition to sonography and computer tomography, MRI is a valuable tool for diagnosing cardiovascular and abdominal diseases, for determining disease severity, and for assessing therapeutic success. MRI techniques have improved over the last few decades, revealing not just morphologic information, but functional information about perfusion, diffusion and hemodynamics as well. Four-dimensional (4D) flow MRI, a time-resolved phase contrast-MRI with three-dimensional (3D) anatomic coverage and velocity encoding along all three flow directions has been used to comprehensively assess complex cardiovascular hemodynamics in multiple regions of the body. The technique enables visualization of 3D blood flow patterns and retrospective quantification of blood flow parameters in a region of interest. Over the last few years, 4D flow MRI has been increasingly performed in the abdominal region. By applying different acceleration techniques, taking 4D flow MRI measurements has dropped to a reasonable scanning time of 8 to 12 min. These new developments have encouraged a growing number of patient studies in the literature validating the technique’s potential for enhanced evaluation of blood flow parameters within the liver’s complex vascular system. The purpose of this review article is to broaden our understanding of 4D flow MRI for the assessment of liver hemodynamics by providing insights into acquisition, data analysis, visualization and quantification. Furthermore, in this article we highlight its development, focussing on the clinical application of the technique.
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49
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DCE-MRI of hepatocellular carcinoma: perfusion quantification with Tofts model versus shutter-speed model--initial experience. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2015; 29:49-58. [PMID: 26646522 DOI: 10.1007/s10334-015-0513-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 11/02/2015] [Accepted: 11/17/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To quantify hepatocellular carcinoma (HCC) perfusion and flow with the fast exchange regime-allowed Shutter-Speed model (SSM) compared to the Tofts model (TM). MATERIALS AND METHODS In this prospective study, 25 patients with HCC underwent DCE-MRI. ROIs were placed in liver parenchyma, portal vein, aorta and HCC lesions. Signal intensities were analyzed employing dual-input TM and SSM models. ART (arterial fraction), K (trans) (contrast agent transfer rate constant from plasma to extravascular extracellular space), ve (extravascular extracellular volume fraction), kep (contrast agent intravasation rate constant), and τi (mean intracellular water molecule lifetime) were compared between liver parenchyma and HCC, and ART, K (trans), v e and k ep were compared between models using Wilcoxon tests and limits of agreement. Test-retest reproducibility was assessed in 10 patients. RESULTS ART and v e obtained with TM; ART, ve, ke and τi obtained with SSM were significantly different between liver parenchyma and HCC (p < 0.04). Parameters showed variable reproducibility (CV range 14.7-66.5% for both models). Liver K (trans) and ve; HCC ve and kep were significantly different when estimated with the two models (p < 0.03). CONCLUSION Our results show differences when computed between the TM and the SSM. However, these differences are smaller than parameter reproducibilities and may be of limited clinical significance.
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50
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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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