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Thakral N, Desalegn H, Diaz LA, Cabrera D, Loomba R, Arrese M, Arab JP. A Precision Medicine Guided Approach to the Utilization of Biomarkers in MASLD. Semin Liver Dis 2024; 44:273-286. [PMID: 38991536 DOI: 10.1055/a-2364-2928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
The new nomenclature of metabolic dysfunction-associated steatotic liver disease (MASLD) emphasizes a positive diagnosis based on cardiometabolic risk factors. This definition is not only less stigmatizing but also allows for subclassification and stratification, thereby addressing the heterogeneity of what was historically referred to as nonalcoholic fatty liver disease. The heterogeneity within this spectrum is influenced by several factors which include but are not limited to demographic/dietary factors, the amount of alcohol use and drinking patterns, metabolic status, gut microbiome, genetic predisposition together with epigenetic factors. The net effect of this dynamic and intricate system-level interaction is reflected in the phenotypic presentation of MASLD. Therefore, the application of precision medicine in this scenario aims at complex phenotyping with consequent individual risk prediction, development of individualized preventive strategies, and improvements in the clinical trial designs. In this review, we aim to highlight the importance of precision medicine approaches in MASLD, including the use of novel biomarkers of disease, and its subsequent utilization in future study designs.
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Affiliation(s)
- Nimish Thakral
- Division of Gastroenterology and Hepatology, University of Kentucky, Lexington, Kentucky
| | - Hailemichael Desalegn
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Luis Antonio Diaz
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Daniel Cabrera
- Centro de Investigación e Innovación Biomédica (CiiB), Universidad de los Andes, Santiago, Chile
- Escuela de Medicina, Facultad de Ciencias Medicas, Universidad Bernardo O'Higgins, Santiago, Chile
| | - Rohit Loomba
- Division of Gastroenterology and Hepatology, MASLD Research Center, University of California San Diego, San Diego, California
| | - Marco Arrese
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Pablo Arab
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
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Kim M, Yoon EL, Lee J, Cho S, Lee CM, Kang BK, Park H, Jun DW, Nah EH. Diagnostic Performance of Noninvasive Tests for Advanced Hepatic Fibrosis in Young Age Population. Clin Gastroenterol Hepatol 2023; 21:1831-1840.e12. [PMID: 37115504 DOI: 10.1016/j.cgh.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 09/22/2022] [Accepted: 10/17/2022] [Indexed: 04/29/2023]
Abstract
BACKGROUND & AIMS Most noninvasive tests (NITs) for hepatic fibrosis are designed for middle-aged patients with chronic liver disease. We compared the diagnostic performance of major NITs (aspartate aminotransferase-to-platelet ratio index [APRI], Fibrosis-4 index, and nonalcoholic fatty liver disease fibrosis score) for a community-based cohort. METHODS This cross-sectional study analyzed 8775 participants who underwent magnetic resonance elastography at community health check-up centers. Advanced hepatic fibrosis (≥F3) was defined by magnetic resonance elastography thresholds of 3.6 kPa. The diagnostic performance of 3 NITs was evaluated according to the etiology of liver disease, sex, metabolic syndrome, obesity, and increased aminotransferase levels in 4 age groups. RESULTS The APRI generally showed the best area under the receiver operating characteristic curve in patients aged 45 years or younger, and it was statistically significant in patients with chronic viral hepatitis and alcoholic fatty liver disease (P < .043). The best APRI cut-off value for detecting advanced hepatic fibrosis was 0.4, with a sensitivity and specificity of 75.8% and 73.5%, respectively, in the community-based cohort. The APRI showed balanced sensitivity and specificity across all age groups, whereas the other metrics showed low sensitivity in those aged <45 and low specificity in those >65 years. CONCLUSIONS The APRI showed better sensitivity and negative predictive value than the Fibrosis-4 index and the nonalcoholic fatty liver disease fibrosis score in community-based populations with mixed etiology, and, thus, can be performed as the primary test in young adults (age, ≤45 y).
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Affiliation(s)
- Mimi Kim
- Department of Radiology, Hanyang University College of Medicine, Seoul, Korea
| | | | - Jonghyun Lee
- Department of Medical and Digital Engineering, Hanyang University College of Engineering, Seoul, Korea
| | - Seon Cho
- Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Korea
| | - Chul-Min Lee
- Department of Radiology, Hanyang University College of Medicine, Seoul, Korea
| | - Bo Kyeong Kang
- Department of Radiology, Hanyang University College of Medicine, Seoul, Korea
| | - Huiyul Park
- Department of Family Medicine, Myongji Hospital, Goyang-si, Gyeonggi-do, Korea
| | - Dae Won Jun
- Internal Medicine, Hanyang University College of Medicine, Seoul, Korea; Department of Medical and Digital Engineering, Hanyang University College of Engineering, Seoul, Korea.
| | - Eun-Hee Nah
- Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Korea.
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Yu JH, Lee HA, Kim SU. Noninvasive imaging biomarkers for liver fibrosis in nonalcoholic fatty liver disease: current and future. Clin Mol Hepatol 2023; 29:S136-S149. [PMID: 36503205 PMCID: PMC10029967 DOI: 10.3350/cmh.2022.0436] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is increasingly prevalent worldwide and becoming a major cause of liver disease-related morbidity and mortality. The presence of liver fibrosis in patients with NAFLD is closely related to prognosis, including the development of hepatocellular carcinoma and other complications of cirrhosis. Therefore, assessment of the presence of significant or advanced liver fibrosis is crucial. Although liver biopsy has been considered the "gold standard" method for evaluating the degree of liver fibrosis, it is not suitable for extensive use in all patients with NAFLD owing to its invasiveness and high cost. Therefore, noninvasive biochemical and imaging biomarkers have been developed to overcome the limitations of liver biopsy. Imaging biomarkers for the stratification of liver fibrosis have been evaluated in patients with NAFLD using different imaging techniques, such as transient elastography, shear wave elastography, and magnetic resonance elastography. Furthermore, artificial intelligence and deep learning methods are increasingly being applied to improve the diagnostic accuracy of imaging techniques and overcome the pitfalls of existing imaging biomarkers. In this review, we describe the usefulness and future prospects of noninvasive imaging biomarkers that have been studied and used to evaluate the degree of liver fibrosis in patients with NAFLD.
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Affiliation(s)
- Jung Hwan Yu
- Department of Internal Medicine, Inha University Hospital and School of Medicine, Incheon, Korea
| | - Han Ah Lee
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Seung Up Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Liver Center, Severance Hospital, Seoul, Korea
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Ozturk A, Olson MC, Samir AE, Venkatesh SK. Liver fibrosis assessment: MR and US elastography. Abdom Radiol (NY) 2022; 47:3037-3050. [PMID: 34687329 PMCID: PMC9033887 DOI: 10.1007/s00261-021-03269-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 01/18/2023]
Abstract
Elastography has emerged as a preferred non-invasive imaging technique for the clinical assessment of liver fibrosis. Elastography methods provide liver stiffness measurement (LSM) as a surrogate quantitative biomarker for fibrosis burden in chronic liver disease (CLD). Elastography can be performed either with ultrasound or MRI. Currently available ultrasound-based methods include strain elastography, two-dimensional shear wave elastography (2D-SWE), point shear wave elastography (pSWE), and vibration-controlled transient elastography (VCTE). MR Elastography (MRE) is widely available as two-dimensional gradient echo MRE (2D-GRE-MRE) technique. US-based methods provide estimated Young's modulus (eYM) and MRE provides magnitude of the complex shear modulus. MRE and ultrasound methods have proven to be accurate methods for detection of advanced liver fibrosis and cirrhosis. Other clinical applications of elastography include liver decompensation prediction, and differentiation of non-alcoholic steatohepatitis (NASH) from simple steatosis (SS). In this review, we briefly describe the different elastography methods, discuss current clinical applications, and provide an overview of advances in the field of liver elastography.
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Affiliation(s)
- Arinc Ozturk
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Michael C Olson
- Division of Abdominal Imaging, Radiology, Mayo Clinic Rochester, 200, First Street SW, Rochester, MN, 55905, USA
| | - Anthony E Samir
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Sudhakar K Venkatesh
- Division of Abdominal Imaging, Radiology, Mayo Clinic Rochester, 200, First Street SW, Rochester, MN, 55905, USA.
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Welle CL, Olson MC, Reeder SB, Venkatesh SK. Magnetic Resonance Imaging of Liver Fibrosis, Fat, and Iron. Radiol Clin North Am 2022; 60:705-716. [PMID: 35989039 DOI: 10.1016/j.rcl.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ajmera V, Nguyen K, Tamaki N, Sharpton S, Bettencourt R, Loomba R. Prognostic utility of magnetic resonance elastography and MEFIB index in predicting liver-related outcomes and mortality in individuals at risk of and with nonalcoholic fatty liver disease. Therap Adv Gastroenterol 2022; 15:17562848221093869. [PMID: 35509420 PMCID: PMC9058353 DOI: 10.1177/17562848221093869] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/25/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Magnetic resonance elastography (MRE) is an accurate biomarker of liver fibrosis; however, limited data characterize its association with outcomes. We aimed to evaluate the association between liver stiffness (LS) on MRE and liver-related outcomes. METHODS This is a longitudinal, retrospective analysis of subjects at risk of NAFLD who had MRE assessment. LS was estimated using MRE, and liver fat was assessed using magnetic resonance imaging proton density fat fraction. Univariable and multivariable survival and regression analyses were used to assess the association between LS on MRE and liver-related outcomes including a cumulative primary outcome of hepatic decompensation, hepatocellular carcinoma (HCC), or death. RESULTS In all, 265 patients (68% women) with a mean age of 50 (±18) years and 44% Hispanic ethnicity and 45.3% with NAFLD were included. A total of 76 liver-related events or death occurred, and there was 453 person-years of follow-up time in 97 patients with available follow-up. Each 1-kPa increase in LS was associated with 2.20-fold (95% CI: 1.70-2.84, p < 0.001) increased odds of prevalent hepatic decompensation or HCC. A positive MEFIB index, a combination of MRE ⩾ 3.3 kPa and FIB-4 ⩾ 1.6, had a strong association with the primary outcome compared with those without, HR = 21.8 (95% CI: 4.28-111.4, p < 0.001). The MEFIB index had a sensitivity of 75% and specificity of 90%, and a negative score was associated with 98% negative predictive value for incident liver-related events or death. CONCLUSION LS assessed by MRE is associated with hepatic decompensation and death, and the MEFIB combination of MRE with FIB-4 may have high negative predictive value for liver-related events.
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Affiliation(s)
- Veeral Ajmera
- NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, 9500 Gilman Drive, ACTRI Building, 1W507, La Jolla, CA 92093-0887, USA
| | - Khang Nguyen
- NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, CA, USA
| | - Nobuharu Tamaki
- NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, CA, USADepartment of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Suzanne Sharpton
- NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, CA, USA
| | - Ricki Bettencourt
- NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, CA, USA
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Sun W, Gao X, Lei H, Wang W, Cao Y. Biophysical Approaches for Applying and Measuring Biological Forces. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2105254. [PMID: 34923777 PMCID: PMC8844594 DOI: 10.1002/advs.202105254] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Indexed: 05/13/2023]
Abstract
Over the past decades, increasing evidence has indicated that mechanical loads can regulate the morphogenesis, proliferation, migration, and apoptosis of living cells. Investigations of how cells sense mechanical stimuli or the mechanotransduction mechanism is an active field of biomaterials and biophysics. Gaining a further understanding of mechanical regulation and depicting the mechanotransduction network inside cells require advanced experimental techniques and new theories. In this review, the fundamental principles of various experimental approaches that have been developed to characterize various types and magnitudes of forces experienced at the cellular and subcellular levels are summarized. The broad applications of these techniques are introduced with an emphasis on the difficulties in implementing these techniques in special biological systems. The advantages and disadvantages of each technique are discussed, which can guide readers to choose the most suitable technique for their questions. A perspective on future directions in this field is also provided. It is anticipated that technical advancement can be a driving force for the development of mechanobiology.
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Affiliation(s)
- Wenxu Sun
- School of SciencesNantong UniversityNantong226019P. R. China
| | - Xiang Gao
- Key Laboratory of Intelligent Optical Sensing and IntegrationNational Laboratory of Solid State Microstructureand Department of PhysicsCollaborative Innovation Center of Advanced MicrostructuresNanjing UniversityNanjing210023P. R. China
- Institute of Brain ScienceNanjing UniversityNanjing210023P. R. China
| | - Hai Lei
- Key Laboratory of Intelligent Optical Sensing and IntegrationNational Laboratory of Solid State Microstructureand Department of PhysicsCollaborative Innovation Center of Advanced MicrostructuresNanjing UniversityNanjing210023P. R. China
- Institute of Brain ScienceNanjing UniversityNanjing210023P. R. China
- Chemistry and Biomedicine Innovation CenterNanjing UniversityNanjing210023P. R. China
| | - Wei Wang
- Key Laboratory of Intelligent Optical Sensing and IntegrationNational Laboratory of Solid State Microstructureand Department of PhysicsCollaborative Innovation Center of Advanced MicrostructuresNanjing UniversityNanjing210023P. R. China
- Institute of Brain ScienceNanjing UniversityNanjing210023P. R. China
| | - Yi Cao
- Key Laboratory of Intelligent Optical Sensing and IntegrationNational Laboratory of Solid State Microstructureand Department of PhysicsCollaborative Innovation Center of Advanced MicrostructuresNanjing UniversityNanjing210023P. R. China
- Institute of Brain ScienceNanjing UniversityNanjing210023P. R. China
- MOE Key Laboratory of High Performance Polymer Materials and TechnologyDepartment of Polymer Science & EngineeringCollege of Chemistry & Chemical EngineeringNanjing UniversityNanjing210023P. R. China
- Chemistry and Biomedicine Innovation CenterNanjing UniversityNanjing210023P. R. China
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Mingkai L, Sizhe W, Xiaoying W, Ying L, Wu B. OUP accepted manuscript. Gastroenterol Rep (Oxf) 2022; 10:goac005. [PMID: 35186298 PMCID: PMC8849285 DOI: 10.1093/gastro/goac005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/24/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background This study aimed to assess the performance of transient elastography (TE), two-dimensional shear wave elastography (2D-SWE), and magnetic resonance elastography (MRE) for staging significant fibrosis and cirrhosis in untreated chronic hepatitis B (CHB) patients. Methods Pubmed, Embase, Web of Science, and Cochrane Library were searched for terms involving CHB, TE, 2D-SWE, and MRE. Other etiologies of chronic liver disease, previous treatment in patients, or articles not published in SCI journals were excluded. Hierarchical non-linear models were used to evaluate the diagnostic accuracy of TE, 2D-SWE, and MRE. Heterogeneity was explored via analysis of threshold effect and meta-regression. Results Twenty-eight articles with a total of 4,540 untreated CHB patients were included. The summary areas under the receiver-operating characteristic curves (AUROCs) using TE, 2D-SWE, and MRE for predicting significant fibrosis (SF) were 0.84, 0.89, and 0.99, respectively. The AUROC values of TE, 2D-SWE, and MRE for staging cirrhosis were 0.9, 0.94, and 0.99, respectively. Based on the meta-analysis of studies with head-to-head comparison, 2D-SWE is superior to TE (0.92 vs 0.85, P < 0.01) in staging significant fibrosis. Conclusion TE, 2D-SWE, and MRE express acceptable diagnostic accuracies in staging significant fibrosis and cirrhosis in untreated CHB patients. 2D-SWE outperforms TE in detecting significant fibrosis in treatment-naive people with hepatitis B virus.
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Affiliation(s)
- Li Mingkai
- Department of Gastroenterology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Liver Disease Research, Guangzhou, Guangdong, P. R. China
| | - Wan Sizhe
- Department of Gastroenterology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Liver Disease Research, Guangzhou, Guangdong, P. R. China
| | - Wu Xiaoying
- Department of Gastroenterology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Liver Disease Research, Guangzhou, Guangdong, P. R. China
| | - Lin Ying
- Department of Gastroenterology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
| | - Bin Wu
- Department of Gastroenterology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China
- Guangdong Provincial Key Laboratory of Liver Disease Research, Guangzhou, Guangdong, P. R. China
- Corresponding author. Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, Guangdong 510630, P. R. China. Tel: +86-20-85253333; Fax: +86-20-85253336;
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Brazilian Society of Hepatology and Brazilian College of Radiology practice guidance for the use of elastography in liver diseases. Ann Hepatol 2021; 22:100341. [PMID: 33737252 DOI: 10.1016/j.aohep.2021.100341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/21/2021] [Accepted: 03/01/2021] [Indexed: 02/07/2023]
Abstract
In 2015 the European Association for the Study of Liver Diseases (EASL) and the Asociación Latinoamericana para el Estudio del Hígado (ALEH) published a guideline for the use of non-invasive markers of liver disease. At that time, this guideline focused on the available data regarding ultrasonic-related elastography methods. Since then, much has been published, including new data about XL probe use in transient elastography, magnetic resonance elastography, and non-invasive liver steatosis evaluation. In order to draw evidence-based guidance concerning the use of elastography for non-invasive assessment of fibrosis and steatosis in different chronic liver diseases, the Brazilian Society of Hepatology (SBH) and the Brazilian College of Radiology (CBR) sponsored a single-topic meeting on October 4th, 2019, at São Paulo, Brazil. The aim was to establish specific recommendations regarding the use of imaging-related non-invasive technology to diagnose liver fibrosis and steatosis based on the discussion of evidence-based topics by an organizing committee of experts. It was submitted online to all SBH and CBR members. The present document is the final version of the manuscript that supports the use of this new technology as an alternative to liver biopsy.
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Clinical and Molecular Biomarkers for Diagnosis and Staging of NAFLD. Int J Mol Sci 2021; 22:ijms222111905. [PMID: 34769333 PMCID: PMC8585051 DOI: 10.3390/ijms222111905] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 10/30/2021] [Accepted: 10/30/2021] [Indexed: 12/16/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most common hepatic pathology in industrialized countries, affecting about 25% of the general population. NAFLD is a benign condition, however, it could evolve toward more serious diseases, including non-alcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and finally, hepatocellular carcinoma (HCC). Liver biopsy is still the gold standard for NAFLD diagnosis. Due to the risks associated with liver biopsy and the impossibility to apply it on a large scale, it is now necessary to identify non-invasive biomarkers, which may reliably identify patients at higher risk of progression. Therefore, several lines of research have tried to address this issue by identifying novel biomarkers using omics approaches, including lipidomics, metabolomics and RNA molecules' profiling. Thus, in this review, we firstly report the conventional biomarkers used in clinical practice for NAFL and NASH diagnosis as well as fibrosis staging, and secondly, we pay attention to novel biomarkers discovered through omics approaches with a particular focus on RNA biomarkers (microRNAs, long-noncoding RNAs), showing promising diagnostic performance for NAFL/NASH diagnosis and fibrosis staging.
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Ajmera V, Liu A, Bettencourt R, Dhar D, Richards L, Loomba R. The impact of genetic risk on liver fibrosis in non-alcoholic fatty liver disease as assessed by magnetic resonance elastography. Aliment Pharmacol Ther 2021; 54:68-77. [PMID: 33975381 PMCID: PMC8985656 DOI: 10.1111/apt.16392] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/22/2021] [Accepted: 04/14/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Variants in multiple genetic loci modify the risk of non-alcoholic fatty liver disease (NAFLD) and cirrhosis but there are limited data on the quantitative impact of variant copies on liver fibrosis. AIM To investigate the effect of PNPLA3, TM6SF2, MBOAT7, GCKR and HSD17B13 genotype on liver fibrosis assessed by magnetic resonance elastography (MRE), a reproducible, accurate, continuous biomarker of liver fibrosis. METHODS This is a cross-sectional analysis derived from a well-characterised cohort at risk for NAFLD who underwent genotyping and MRE assessment. Liver stiffness (LS) was estimated using MRE and advanced fibrosis was defined as liver stiffness ≥3.63 kilopascals (kPa). Univariable and multivariable linear and logistic regression analysis, were used to assess the association between genotype and MRE. RESULTS Two hundred sixty-four patients (63% women) with a mean age 53 (±17) years, and 31% Hispanic ethnicity with genotyping and MRE were included. The odds of advanced fibrosis were 3.1 (95% CI: 1.1-8.9, P = 0.04) for CG and 6.5 (95% CI: 2.2-18.9, P < 0.01) for GG compared to CC PNPLA3 genotype. Each PNPLA3 risk variant copy was associated with 0.40 kPa (95% CI: 0.19-0.61, P < 0.01) increase in LS on MRE in analysis adjusted for age, sex and BMI and there was significant genotype-age interaction (P < 0.01). Conversely, the protective TA allele in HSD17B13 was associated with a -0.41 kPa (95% CI: -0.76 to -0.05, P = 0.03) decrease in liver stiffness on MRE multivariable analysis. CONCLUSION Knowledge of PNPLA3 and HSD17B13 genotype may assist in the non-invasive risk stratification of NAFLD with closer monitoring recommended for those with high genetic risk.
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Affiliation(s)
- Veeral Ajmera
- Division of Gastroenterology, NAFLD Research Center, University of California at San Diego, La Jolla, CA, USA.,Division of Gastroenterology, University of California at San Diego, La Jolla, CA, USA
| | - Amy Liu
- Division of Gastroenterology, NAFLD Research Center, University of California at San Diego, La Jolla, CA, USA
| | - Ricki Bettencourt
- Division of Gastroenterology, NAFLD Research Center, University of California at San Diego, La Jolla, CA, USA
| | - Debanjan Dhar
- Division of Gastroenterology, University of California at San Diego, La Jolla, CA, USA
| | - Lisa Richards
- Division of Gastroenterology, NAFLD Research Center, University of California at San Diego, La Jolla, CA, USA
| | - Rohit Loomba
- Division of Gastroenterology, NAFLD Research Center, University of California at San Diego, La Jolla, CA, USA.,Division of Gastroenterology, University of California at San Diego, La Jolla, CA, USA
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Kumada T, Toyoda H, Yasuda S, Sone Y, Ogawa S, Takeshima K, Tada T, Ito T, Sumida Y, Tanaka J. Prediction of Hepatocellular Carcinoma by Liver Stiffness Measurements Using Magnetic Resonance Elastography After Eradicating Hepatitis C Virus. Clin Transl Gastroenterol 2021; 12:e00337. [PMID: 33888672 PMCID: PMC8078363 DOI: 10.14309/ctg.0000000000000337] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/05/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Liver fibrosis stage is one of the most important factors in stratifying the risk of developing hepatocellular carcinoma (HCC). We evaluated the usefulness of liver stiffness measured by magnetic resonance elastography (MRE) to stratify the risk of developing HCC in patients who underwent MRE before receiving direct-acting antivirals (DAAs) and subsequently achieved sustained virological response (SVR). METHODS A total of 537 consecutive patients with persistent hepatitis C virus who underwent initial MRE before DAA therapy and achieved SVR were enrolled. Factors associated with HCC development were analyzed by univariate and multivariate Cox proportional hazards models. RESULTS Albumin-bilirubin score ≥ -2.60 (adjusted hazard ratio [aHR] 6.303), fibrosis-4 (FIB-4) score >3.25 (aHR 7.676), and MRE value ≥4.5 kPa (aHR 13.190) were associated with HCC development according to a univariate Cox proportional hazards model. A multivariate Cox proportional hazards model showed that an MRE value ≥4.5 kPa (aHR 7.301) was the only factor independently associated with HCC development. Even in patients with an FIB-4 score >3.25, the cumulative incidence rate of HCC development in those with an MRE value <4.5 kPa was significantly lower than that in patients with an MRE value ≥4.5 kPa. DISCUSSION Liver stiffness measured by MRE before DAA therapy was an excellent marker for predicting subsequent HCC development in patients with hepatitis C virus infection who achieved SVR. The same results were observed in patients with high FIB-4 scores.
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Affiliation(s)
- Takashi Kumada
- Department of Nursing, Faculty of Nursing, Gifu Kyoritsu University, Ogaki, Gifu, Japan
| | - Hidenori Toyoda
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Satoshi Yasuda
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Yasuhiro Sone
- Department of Radiology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Sadanobu Ogawa
- Department of Imaging Diagnosis, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Kenji Takeshima
- Department of Imaging Diagnosis, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Toshifumi Tada
- Department of Internal Medicine, Himeji Red Cross Hospital, Himeji, Hyougo, Japan
| | - Takanori Ito
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoshio Sumida
- Division of Hepatology and Pancreatology, Department of Internal Medicine, Aichi Medical University, Nagakute, Aichi, Japan
| | - Junko Tanaka
- Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
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Mori N, Nakagawa S, Iwata K. [Optimization of External Driver Amplitude in Magnetic Resonance Elastography of the Liver: Relationship between Appropriate External Driver Amplitude and Indicators of Physical Constitution]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2021; 77:263-271. [PMID: 33746174 DOI: 10.6009/jjrt.2021_jsrt_77.3.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Magnetic resonance elastography (MRE) of the liver was performed to examine the appropriate external driver amplitude according to the physique of the subject and the index useful for determining the physique. METHODS For 60 subjects who underwent MRE examination, we measured the unmeasurable elastic modulus area in the liver based on the stiffness map obtained from MRE. The external driver amplitude with the smallest unmeasurable elastic modulus area was taken as the appropriate external driver amplitude for the subject. The receiver operating characteristic (ROC) analysis was performed on the indicators of physical constitution (abdominal depth, waist circumference, body weight and body mass index (BMI) ) and external driver amplitude of 30%, 50% and 70%. BMI was the most appropriate tool for the comparison of indicators of physical constitution. RESULT The appropriate external driver amplitude was 30% when the cutoff value of BMI was less than 25.3 kg/m², 70% when it was 31.0 kg/m² or more, and 50% when it was between them. CONCLUSION It is considered that an accurate elastic modulus can be obtained by setting an appropriate indicator of physical constitution and external driver amplitude according to physique in MRE.
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Affiliation(s)
- Naoto Mori
- Section of Radiological Technology, Department of Medical Technology, Asahikawa Medical University Hospital
| | - Sadahiro Nakagawa
- Section of Radiological Technology, Department of Medical Technology, Asahikawa Medical University Hospital
| | - Kunihiro Iwata
- Section of Radiological Technology, Department of Medical Technology, Asahikawa Medical University Hospital
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MR Elastography. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00058-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Plaikner M, Kremser C, Viveiros A, Zoller H, Henninger B. [Magnetic resonance elastography of the liver : Worth knowing for clinical routine]. Radiologe 2020; 60:966-978. [PMID: 32399783 DOI: 10.1007/s00117-020-00690-6] [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] [Indexed: 11/27/2022]
Abstract
BACKGROUND Magnetic resonance elastography (MRE) is a noninvasive, quantitative, MRI-based method to evaluate liver stiffness. Beside biopsy and ultrasound elastography, this imaging method plays in many places a significant role in the detection and additive characterization of chronic liver disease. OBJECTIVES, MATERIALS AND METHODS Based on the literature, a brief review of the underlying method and the commercially available products is given. Furthermore, the practical procedure, the analysis, and the interpretation of clinically relevant questions are illustrated and a comparison with ultrasound elastography is provided. RESULTS This relative "young" MRI method allows extensive evaluation of mechanical properties of the liver and is an important diagnostic tool especially in follow-up examinations. The MRE of the liver is with a maximum technical failure rate of 5.8% a robust technique with high accuracy and an excellent re-test reliability as well as intra- and interobserver reproducibility. There is a high diagnostic certainty within the framework of most important clinical indications, the quantification of fibrosis, and with a very good correlation with the "gold standard" biopsy. CONCLUSION Based on its rising clinical relevance and the broad usage, MRE of the liver is increasingly used in many centers and in routine liver protocols. Therefore, basic knowledge of this method is essential for every radiologist.
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Affiliation(s)
- Michaela Plaikner
- Radiologie, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.
| | - Christian Kremser
- Radiologie, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - André Viveiros
- Innere Medizin I, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Heinz Zoller
- Innere Medizin I, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Benjamin Henninger
- Radiologie, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
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MR elastography of liver: current status and future perspectives. Abdom Radiol (NY) 2020; 45:3444-3462. [PMID: 32705312 DOI: 10.1007/s00261-020-02656-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/06/2020] [Accepted: 07/09/2020] [Indexed: 02/08/2023]
Abstract
Non-invasive evaluation of liver fibrosis has evolved over the last couple of decades. Currently, elastography techniques are the most widely used non-invasive methods for clinical evaluation of chronic liver disease (CLD). MR elastography (MRE) of the liver has been used in the clinical practice for nearly a decade and continues to be widely accepted for detection and staging of liver fibrosis. With MRE, one can directly visualize propagating shear waves through the liver and an inversion algorithm in the scanner automatically converts the shear wave properties into an elastogram (stiffness map) on which liver stiffness can be calculated. The commonly used MRE method, two-dimensional gradient recalled echo (2D-GRE) sequence has produced excellent results in the evaluation of liver fibrosis in CLD from various etiologies and newer clinical indications continue to emerge. Advances in MRE technique, including 3D MRE, automated liver elasticity calculation, improvements in shear wave delivery and patient experience, are promising to provide a faster and more reliable MRE of liver. Innovations, including evaluation of mechanical parameters, such as loss modulus, displacement, and volumetric strain, are promising for comprehensive evaluation of CLD as well as understanding pathophysiology, and in differentiating various etiologies of CLD. In this review, the current status of the MRE of liver in CLD are outlined and followed by a brief description of advanced techniques and innovations in MRE of liver.
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Long MT, Gandhi S, Loomba R. Advances in non-invasive biomarkers for the diagnosis and monitoring of non-alcoholic fatty liver disease. Metabolism 2020; 111S:154259. [PMID: 32387227 PMCID: PMC7529729 DOI: 10.1016/j.metabol.2020.154259] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 12/11/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is now the most common chronic liver disease in the United States, affecting approximately 1 out of every 4 Americans. NAFLD is a spectrum of disorders including simple steatosis, characterized by the presence of hepatic steatosis with minimal inflammation, and nonalcoholic steatohepatitis (NASH), characterized by the presence of hepatic steatosis with lobular inflammation, ballooning with or without peri-sinusoidal fibrosis. NASH may lead to progressive fibrosis, and therefore, Individuals with NASH and, in particular, hepatic fibrosis are at increased risk for both liver- and cardiovascular-related outcomes compared to those with steatosis alone. New treatments for NASH and hepatic fibrosis are emerging, so now, more than ever, it is important to identify individuals with more advanced disease who may be candidates for therapy. Noninvasive methods to accurately diagnosis, risk stratify, and monitor both NASH and fibrosis are critically needed. Moreover, since clinically relevant outcomes, such as developing end stage liver disease or liver cancer, take many years to develop, reliable surrogate markers of outcome measures are needed to identify and evaluate potential therapies. In this review, we discuss methods to noninvasively diagnosis and monitor both NASH and fibrosis.
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Affiliation(s)
- Michelle T Long
- Section of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States of America.
| | - Sanil Gandhi
- Boston University, Boston, MA, United States of America
| | - Rohit Loomba
- Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, CA, United States of America; NAFLD Research Center, University of California at San Diego, La Jolla, CA, United States of America; Division of Epidemiology, Department of Family and Preventive, University of California at San Diego, La Jolla, CA, United States of America.
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Trout AT, Anupindi SA, Gee MS, Khanna G, Xanthakos SA, Serai SD, Baikpour M, Calle-Toro JS, Ozturk A, Zhang B, Dillman JR. Normal Liver Stiffness Measured with MR Elastography in Children. Radiology 2020; 297:663-669. [PMID: 32960728 DOI: 10.1148/radiol.2020201513] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Stiffness thresholds for liver MR elastography in children vary between studies and may differ from thresholds in adults. Normative liver stiffness data are needed to optimize diagnostic thresholds for children. Purpose To determine normal liver stiffness, and associated normal ranges for children, as measured with MR elastography across vendors and field strengths. Materials and Methods This was a prospective multicenter cohort study (ClinicalTrials.gov identifier: NCT03235414). Volunteers aged 7-17.9 years without a known history of liver disease were recruited at four sites for a research MRI and blood draw between February 2018 and October 2019. MRI was performed on three vendor platforms and at two field strengths (1.5 T and 3.0 T). All MRI scans were centrally analyzed; stiffness, proton density fat fraction (PDFF), and R2* values were expressed as means of means. Mean and 95% confidence intervals (CIs) for liver stiffness were calculated. Pearson correlation coefficient (r), two-sample t test, or analysis of variance was used to assess univariable associations. Results Seventy-one volunteers had complete data and no documented exclusion criterion (median age, 12 years; interquartile range [IQR], 10-15 years; 39 female participants). Median body mass index percentile was 54% (IQR, 32.5%-69.5%). Mean liver stiffness was 2.1 kPa (95% CI: 2.0, 2.2 kPa) with mean ± 1.96 kPa standard deviation of 1.5-2.8 kPa. Median liver PDFF was 2.0% (IQR, 1.7%-2.6%). There was no association between liver stiffness and any patient variable or MRI scanner factor. Conclusion Mean liver stiffness measured with MR elastography in children without liver disease was 2.1 kPa (similar to that in adults). The 95th percentile of normal liver stiffness was 2.8 kPa. Liver stiffness was independent of sex, age, or body mass index and did not vary with MRI scanner vendor or field strength. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Yin in this issue.
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Affiliation(s)
- Andrew T Trout
- From the Department of Radiology (A.T.T., J.R.D.), Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), and Division of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229; Departments of Radiology (A.T.T., J.R.D.) and Pediatrics (A.T.T., S.A.X., B.Z.), University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (S.A.A., S.D.S., J.S.C.T.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (S.A.A., S.D.S.); Department of Radiology (M.S.G.) and Center for Ultrasound Research & Translation, Department of Radiology (M.B., A.O.), Massachusetts General Hospital, Boston, Mass; Department of Radiology, Harvard Medical School, Boston, Mass (M.S.G.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (G.K.)
| | - Sudha A Anupindi
- From the Department of Radiology (A.T.T., J.R.D.), Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), and Division of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229; Departments of Radiology (A.T.T., J.R.D.) and Pediatrics (A.T.T., S.A.X., B.Z.), University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (S.A.A., S.D.S., J.S.C.T.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (S.A.A., S.D.S.); Department of Radiology (M.S.G.) and Center for Ultrasound Research & Translation, Department of Radiology (M.B., A.O.), Massachusetts General Hospital, Boston, Mass; Department of Radiology, Harvard Medical School, Boston, Mass (M.S.G.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (G.K.)
| | - Michael S Gee
- From the Department of Radiology (A.T.T., J.R.D.), Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), and Division of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229; Departments of Radiology (A.T.T., J.R.D.) and Pediatrics (A.T.T., S.A.X., B.Z.), University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (S.A.A., S.D.S., J.S.C.T.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (S.A.A., S.D.S.); Department of Radiology (M.S.G.) and Center for Ultrasound Research & Translation, Department of Radiology (M.B., A.O.), Massachusetts General Hospital, Boston, Mass; Department of Radiology, Harvard Medical School, Boston, Mass (M.S.G.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (G.K.)
| | - Geetika Khanna
- From the Department of Radiology (A.T.T., J.R.D.), Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), and Division of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229; Departments of Radiology (A.T.T., J.R.D.) and Pediatrics (A.T.T., S.A.X., B.Z.), University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (S.A.A., S.D.S., J.S.C.T.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (S.A.A., S.D.S.); Department of Radiology (M.S.G.) and Center for Ultrasound Research & Translation, Department of Radiology (M.B., A.O.), Massachusetts General Hospital, Boston, Mass; Department of Radiology, Harvard Medical School, Boston, Mass (M.S.G.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (G.K.)
| | - Stavra A Xanthakos
- From the Department of Radiology (A.T.T., J.R.D.), Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), and Division of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229; Departments of Radiology (A.T.T., J.R.D.) and Pediatrics (A.T.T., S.A.X., B.Z.), University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (S.A.A., S.D.S., J.S.C.T.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (S.A.A., S.D.S.); Department of Radiology (M.S.G.) and Center for Ultrasound Research & Translation, Department of Radiology (M.B., A.O.), Massachusetts General Hospital, Boston, Mass; Department of Radiology, Harvard Medical School, Boston, Mass (M.S.G.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (G.K.)
| | - Suraj D Serai
- From the Department of Radiology (A.T.T., J.R.D.), Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), and Division of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229; Departments of Radiology (A.T.T., J.R.D.) and Pediatrics (A.T.T., S.A.X., B.Z.), University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (S.A.A., S.D.S., J.S.C.T.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (S.A.A., S.D.S.); Department of Radiology (M.S.G.) and Center for Ultrasound Research & Translation, Department of Radiology (M.B., A.O.), Massachusetts General Hospital, Boston, Mass; Department of Radiology, Harvard Medical School, Boston, Mass (M.S.G.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (G.K.)
| | - Masoud Baikpour
- From the Department of Radiology (A.T.T., J.R.D.), Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), and Division of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229; Departments of Radiology (A.T.T., J.R.D.) and Pediatrics (A.T.T., S.A.X., B.Z.), University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (S.A.A., S.D.S., J.S.C.T.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (S.A.A., S.D.S.); Department of Radiology (M.S.G.) and Center for Ultrasound Research & Translation, Department of Radiology (M.B., A.O.), Massachusetts General Hospital, Boston, Mass; Department of Radiology, Harvard Medical School, Boston, Mass (M.S.G.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (G.K.)
| | - Juan S Calle-Toro
- From the Department of Radiology (A.T.T., J.R.D.), Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), and Division of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229; Departments of Radiology (A.T.T., J.R.D.) and Pediatrics (A.T.T., S.A.X., B.Z.), University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (S.A.A., S.D.S., J.S.C.T.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (S.A.A., S.D.S.); Department of Radiology (M.S.G.) and Center for Ultrasound Research & Translation, Department of Radiology (M.B., A.O.), Massachusetts General Hospital, Boston, Mass; Department of Radiology, Harvard Medical School, Boston, Mass (M.S.G.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (G.K.)
| | - Arinc Ozturk
- From the Department of Radiology (A.T.T., J.R.D.), Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), and Division of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229; Departments of Radiology (A.T.T., J.R.D.) and Pediatrics (A.T.T., S.A.X., B.Z.), University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (S.A.A., S.D.S., J.S.C.T.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (S.A.A., S.D.S.); Department of Radiology (M.S.G.) and Center for Ultrasound Research & Translation, Department of Radiology (M.B., A.O.), Massachusetts General Hospital, Boston, Mass; Department of Radiology, Harvard Medical School, Boston, Mass (M.S.G.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (G.K.)
| | - Bin Zhang
- From the Department of Radiology (A.T.T., J.R.D.), Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), and Division of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229; Departments of Radiology (A.T.T., J.R.D.) and Pediatrics (A.T.T., S.A.X., B.Z.), University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (S.A.A., S.D.S., J.S.C.T.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (S.A.A., S.D.S.); Department of Radiology (M.S.G.) and Center for Ultrasound Research & Translation, Department of Radiology (M.B., A.O.), Massachusetts General Hospital, Boston, Mass; Department of Radiology, Harvard Medical School, Boston, Mass (M.S.G.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (G.K.)
| | - Jonathan R Dillman
- From the Department of Radiology (A.T.T., J.R.D.), Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), and Division of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229; Departments of Radiology (A.T.T., J.R.D.) and Pediatrics (A.T.T., S.A.X., B.Z.), University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pa (S.A.A., S.D.S., J.S.C.T.); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (S.A.A., S.D.S.); Department of Radiology (M.S.G.) and Center for Ultrasound Research & Translation, Department of Radiology (M.B., A.O.), Massachusetts General Hospital, Boston, Mass; Department of Radiology, Harvard Medical School, Boston, Mass (M.S.G.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (G.K.)
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Kromrey ML, Le Bihan D, Ichikawa S, Motosugi U. Diffusion-weighted MRI-based Virtual Elastography for the Assessment of Liver Fibrosis. Radiology 2020; 295:127-135. [DOI: 10.1148/radiol.2020191498] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Ajmera VH, Liu A, Singh S, Yachoa G, Ramey M, Bhargava M, Zamani A, Lopez S, Mangla N, Bettencourt R, Rizo E, Valasek M, Behling C, Richards L, Sirlin C, Loomba R. Clinical Utility of an Increase in Magnetic Resonance Elastography in Predicting Fibrosis Progression in Nonalcoholic Fatty Liver Disease. Hepatology 2020; 71:849-860. [PMID: 31556124 PMCID: PMC7828573 DOI: 10.1002/hep.30974] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 09/03/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Cross-sectional studies have shown that magnetic resonance elastography (MRE) is accurate in the noninvasive detection of advanced fibrosis in nonalcoholic fatty liver disease (NAFLD). However, there are limited data on the longitudinal association between an increase in liver stiffness on MRE and fibrosis progression in NAFLD. Therefore, using a well-characterized prospective cohort of patients with biopsy-proven NAFLD, we aimed to examine the longitudinal association between a 15% increase in liver stiffness on MRE and fibrosis progression in NAFLD. APPROACH AND RESULTS This prospective cohort study included 102 patients (62.7% women) with biopsy-proven NAFLD who underwent contemporaneous MRE and liver biopsy at baseline followed by a repeat paired liver biopsy and MRE assessment. The primary outcome was odds of fibrosis progression by one or more stage as assessed by the Nonalcoholic Steatohepatitis Clinical Research Network histologic scoring system. The mean (±SD) of age and body mass index (BMI) were 52 (±14) years and 32.6 (±5.3) kg/m2 , respectively. The median time interval between the two paired assessments was 1.4 years (interquartile range 2.15 years). The number of patients with fibrosis stages 0, 1, 2, 3, and 4 was 27, 36, 12, 17, and 10, respectively. In unadjusted analysis, a 15% increase in MRE was associated with increased odds of histologic fibrosis progression (odds ratio [OR], 3.56; 95% confidence interval [CI], 1.17-10.76; P = 0.0248). These findings remained clinically and statistically significant even after multivariable adjustment for age, sex, and BMI (adjusted OR, 3.36; 95% CI, 1.10-10.31; P = 0.0339). A 15% increase in MRE was the strongest predictor of progression to advanced fibrosis (OR, 4.90; 95% CI, 1.35-17.84; P = 0.0159). CONCLUSIONS A 15% increase in liver stiffness on MRE may be associated with histologic fibrosis progression and progression from early fibrosis to advanced fibrosis.
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Affiliation(s)
- Veeral H. Ajmera
- NAFLD Research Center,Division of Gastroenterology, Department of Medicine
| | | | | | | | | | | | | | | | | | | | | | - Mark Valasek
- Department of Pathology, University of California at San Diego, La Jolla, CA
| | | | | | - Claude Sirlin
- Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, CA
| | - Rohit Loomba
- NAFLD Research Center,Division of Gastroenterology, Department of Medicine
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Kang KA, Jun DW, Kim MS, Kwon HJ, Nguyen MH. Prevalence of significant hepatic fibrosis using magnetic resonance elastography in a health check-up clinic population. Aliment Pharmacol Ther 2020; 51:388-396. [PMID: 31943268 DOI: 10.1111/apt.15626] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/09/2019] [Accepted: 12/09/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Significant hepatic fibrosis is associated with higher mortality. However, data on the estimated prevalence of liver fibrosis in the general population are scarce. AIM To use magnetic resonance elastography (MRE) to investigate the prevalence of hepatic fibrosis in a Korean health check-up clinic cohort. METHODS We enrolled 2170 participants at our health check-up clinic between January 2015 and May 2018, all of whom had MR with chemical shift technique and MRE. The primary objective was to estimate the prevalence of liver fibrosis. For generalisation, sex- and age-standardised prevalence was calculated based on the Korean Statistical Information Service (KOSIS) during the period 2015-2018. RESULTS The prevalence of F2 (≥3.0 kPa) and F3 (≥3.6 kPa) in the overall cohort was 5.1% and 1.3% respectively (sex- and age-adjusted prevalence of 3.8% and 1.3%). Non-alcoholic fatty liver disease (NAFLD) prevalence (>5% fat fraction) was 27.7% in the average risk population (after excluding alcohol use and viral hepatitis), and the prevalence of significant and advanced fibrosis in NAFLD participants was 8.0% and 1.5% respectively. In participants with diabetes, 12.5% had ≥F2 and 4.3% ≥F3. In participants with NAFLD plus diabetes, 24.1% had ≥F2 and 6.0% ≥F3. On multivariate analysis, only age, insulin, diabetes and fatty liver on MR were independently associated with significant fibrosis. CONCLUSIONS In a Korean health check-up clinic setting, the prevalence of significant and advanced liver fibrosis was 5.1% and 1.3% (sex- and age-adjusted prevalence of 3.8% and 1.3%). The prevalence of advanced liver fibrosis was five times higher for diabetic participants with NAFLD.
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Affiliation(s)
- Kyung A Kang
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dae Won Jun
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Mi Sung Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heon-Ju Kwon
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
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Saito S. [7. Reproducibility of Liver Magnetic Resonance Elastography (MRE) Measurement and Its Affecting Factors]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2019; 75:1484-1490. [PMID: 31866649 DOI: 10.6009/jjrt.2019_jsrt_75.12.1484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Shigeyoshi Saito
- Department of Medical Physics and Engineering, Division of Health Sciences, Osaka University Graduate School of Medicine.,Department of Biomedical Imaging, National Cardiovascular and Cerebral Research Center
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23
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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: 7.0] [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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24
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Kim DW, Kim SY, Yoon HM, Kim KW, Byun JH. Comparison of technical failure of MR elastography for measuring liver stiffness between gradient‐recalled echo and spin‐echo echo‐planar imaging: A systematic review and meta‐analysis. J Magn Reson Imaging 2019; 51:1086-1102. [DOI: 10.1002/jmri.26918] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/14/2019] [Indexed: 12/14/2022] Open
Affiliation(s)
- Dong Wook Kim
- The Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical Center Seoul Republic of Korea
| | - So Yeon Kim
- The Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical Center Seoul Republic of Korea
| | - Hee Mang Yoon
- The Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical Center Seoul Republic of Korea
| | - Kyung Won Kim
- The Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical Center Seoul Republic of Korea
| | - Jae Ho Byun
- The Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical Center Seoul Republic of Korea
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25
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Sawh MC, Newton KP, Goyal NP, Angeles JE, Harlow K, Bross C, Schlein AN, Hooker JC, Sy EZ, Glaser KJ, Yin M, Ehman RL, Sirlin CB, Schwimmer JB. Normal range for MR elastography measured liver stiffness in children without liver disease. J Magn Reson Imaging 2019; 51:919-927. [PMID: 31452280 DOI: 10.1002/jmri.26905] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/05/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Magnetic resonance elastography (MRE) can determine the presence and stage of liver fibrosis. Data on normative MRE values, while reported in adults, are limited in children. PURPOSE To determine the distribution of MRE-measured liver stiffness in children without liver disease. STUDY TYPE Prospective, observational. POPULATION Eighty-one healthy children (mean 12.6 ± 2.6 years, range 8-17 years). FIELD STRENGTH/SEQUENCE 3.0T Signa HDxt, General Electric MR Scanner; 2D GRE MRE sequence. ASSESSMENT History, examination, laboratory evaluation, and (MR) exams (proton density fat fraction, PDFF, and MRE) were performed. MR elastograms were analyzed manually at two reading centers and compared with each other for agreement and with published values in healthy adults and thresholds for fibrosis in adult and pediatric patients. STATISTICAL TESTS Descriptive statistics, Bland-Altman analysis, t-test to compare hepatic stiffness values with reference standards. RESULTS Stiffness values obtained at both reading centers were similar, without significant bias (P = 0.362) and with excellent correlation (intraclass correlation coefficient [ICC] = 0.782). Mean hepatic stiffness value for the study population was 2.45 ± 0.35 kPa (95th percentile 3.19 kPa), which was significantly higher than reported values for healthy adult subjects (2.10 ± 0.23 kPa, P < 0.001). In all, 74-85% of subjects had stiffness measurements suggestive of no fibrosis. DATA CONCLUSION Mean liver stiffness measured with MRE in this cohort was significantly higher than that reported in healthy adults. Despite rigorous screening, some healthy children had stiffness measurements suggestive of liver fibrosis using current published thresholds. Although MRE has the potential to provide noninvasive assessment in patients with suspected hepatic disease, further refinement of this technology will help advance its use as a diagnostic tool for evidence of fibrosis in pediatric populations. LEVEL OF EVIDENCE 1 Technical Efficacy: 5 J. Magn. Reson. Imaging 2020;51:919-927.
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Affiliation(s)
- Mary Catherine Sawh
- The Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California San Diego School of Medicine, La Jolla, California, USA.,Department of Gastroenterology, Rady Children's Hospital, San Diego, California, USA
| | - Kimberly P Newton
- The Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California San Diego School of Medicine, La Jolla, California, USA.,Department of Gastroenterology, Rady Children's Hospital, San Diego, California, USA
| | - Nidhi P Goyal
- The Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California San Diego School of Medicine, La Jolla, California, USA.,Department of Gastroenterology, Rady Children's Hospital, San Diego, California, USA
| | - Jorge Eduardo Angeles
- The Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Kathryn Harlow
- The Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California San Diego School of Medicine, La Jolla, California, USA.,Department of Gastroenterology, Rady Children's Hospital, San Diego, California, USA
| | - Craig Bross
- The Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Alexandra N Schlein
- Liver Imaging Group, Department of Radiology, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Jonathan C Hooker
- Liver Imaging Group, Department of Radiology, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Ethan Z Sy
- Liver Imaging Group, Department of Radiology, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Kevin J Glaser
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Meng Yin
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard L Ehman
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Jeffrey B Schwimmer
- The Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California San Diego School of Medicine, La Jolla, California, USA.,Department of Gastroenterology, Rady Children's Hospital, San Diego, California, USA
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26
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Park HS, Choe WH, Han HS, Yu MH, Kim YJ, Jung SI, Kim JH, Kwon SY. Assessing significant fibrosis using imaging-based elastography in chronic hepatitis B patients: Pilot study. World J Gastroenterol 2019; 25:3256-3267. [PMID: 31333316 PMCID: PMC6626721 DOI: 10.3748/wjg.v25.i25.3256] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/20/2019] [Accepted: 06/08/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Accurate detection of significant fibrosis (fibrosis stage 2 or higher on the METAVIR scale) is important especially for chronic hepatitis B (CHB) patients with high viral loads but with normal or mildly elevated alanine aminotransferase (ALT) levels because the presence of significant fibrosis is accepted as the indication for antiviral treatment. Liver biopsy is the reference standard for diagnosing significant fibrosis, but it is an invasive procedure. Consequently, noninvasive imaging-based measurements, such as magnetic resonance elastography (MRE) or two-dimensional shear-wave elastography (2D-SWE), have been proposed for the quantitative assessment of liver fibrosis.
AIM To explore MRE and 2D-SWE to identify fibrosis stage, and to compare their performance with that of serum-based indices.
METHODS The study enrolled 63 treatment-naïve CHB patients with high viral loads but with normal or mildly elevated ALT levels who underwent liver biopsy before a decision was made to initiate antiviral therapy. MRE and 2D-SWE were performed, and serum-based indices, such as FIB-4 and aspartate transaminase to platelet ratio index (APRI), were calculated. The diagnostic performances of MRE, 2D-SWE, FIB-4, and APRI for assessing significant fibrosis (≥ F2) and cirrhosis (F4) were evaluated with liver histology as the reference standard, using receiver operating characteristic analyses.
RESULTS The liver fibrosis stage was F0/F1 in 19, F2 in 14, F3 in 14, and F4 in 16 patients, respectively. MRE significantly discriminated F2 from F0/1 (P = 0.022), whereas 2D-SWE showed a broad overlap in distinguishing those stages. MRE showed a higher correlation coefficient value with fibrosis stage than 2D-SWE with fibrosis stage (0.869 vs 0.649, Spearman test; P < 0.001). Multivariate linear regression analyses showed that fibrosis stage was the only factor affecting the values of MRE (P < 0.001), whereas body mass index (P = 0.042) and fibrosis stage (P < 0.001) were independent factors affecting 2D-SWE values. MRE performance for diagnosing significant fibrosis was better [area under the curve (AUC) = 0.906, positive predictive value (PPV) 97.3%, negative predictive value (NPV) 69.2%] than that of FIB-4 (AUC = 0.697, P = 0.002) and APRI (AUC = 0.717, P = 0.010), whereas the performance of 2D-SWE (AUC = 0.843, PPV 86%, NPV 65%) was not significantly different from that of FIB-4 or APRI.
CONCLUSION Compared to SWE, MRE might be more precise non-invasive assessment for depicting significant fibrosis and for making-decision to initiate antiviral-therapy in treatment-naïve CHB patients with normal or mildly-elevated ALT levels.
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Affiliation(s)
- Hee Sun Park
- Department of Radiology, Konkuk University School of Medicine, Seoul 05030, South Korea
| | - Won Hyeok Choe
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul 05030, South Korea
| | - Hye Seung Han
- Department of Pathology, Konkuk University School of Medicine, Seoul 05030, South Korea
| | - Mi Hye Yu
- Department of Radiology, Konkuk University School of Medicine, Seoul 05030, South Korea
| | - Young Jun Kim
- Department of Radiology, Konkuk University School of Medicine, Seoul 05030, South Korea
| | - Sung Il Jung
- Department of Radiology, Konkuk University School of Medicine, Seoul 05030, South Korea
| | - Jeong Han Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul 05030, South Korea
| | - So Young Kwon
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul 05030, South Korea
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27
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Lefebvre T, Wartelle-Bladou C, Wong P, Sebastiani G, Giard JM, Castel H, Murphy-Lavallée J, Olivié D, Ilinca A, Sylvestre MP, Gilbert G, Gao ZH, Nguyen BN, Cloutier G, Tang A. Prospective comparison of transient, point shear wave, and magnetic resonance elastography for staging liver fibrosis. Eur Radiol 2019; 29:6477-6488. [PMID: 31278577 DOI: 10.1007/s00330-019-06331-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/16/2019] [Accepted: 06/13/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To perform head-to-head comparisons of the feasibility and diagnostic performance of transient elastography (TE), point shear-wave elastography (pSWE), and magnetic resonance elastography (MRE). METHODS This prospective, cross-sectional, dual-center imaging study included 100 patients with known or suspected chronic liver disease caused by hepatitis B or C virus, nonalcoholic fatty liver disease, or autoimmune hepatitis identified between 2014 and 2018. Liver stiffness measured with the three elastographic techniques was obtained within 6 weeks of a liver biopsy. Confounding effects of inflammation and steatosis on association between fibrosis and liver stiffness were assessed. Obuchowski scores and AUCs for staging fibrosis were evaluated and the latter were compared using the DeLong method. RESULTS TE, pSWE, and MRE were technically feasible and reliable in 92%, 79%, and 91% subjects, respectively. At univariate analysis, liver stiffness measured by all techniques increased with fibrosis stages and inflammation and decreased with steatosis. For classification of dichotomized fibrosis stages, the AUCs were significantly higher for distinguishing stages F0 vs. ≥ F1 with MRE than with TE (0.88 vs. 0.71; p < 0.05) or pSWE (0.88 vs. 0.73; p < 0.05), and for distinguishing stages ≤ F1 vs. ≥ F2 with MRE than with TE (0.85 vs. 0.75; p < 0.05). TE, pSWE, and MRE Obuchowski scores for staging fibrosis stages were respectively 0.89 (95% CI 0.85-0.93), 0.90 (95% CI 0.85-0.94), and 0.94 (95% CI 0.91-0.96). CONCLUSION MRE provided a higher diagnostic performance than TE and pSWE for staging early stages of liver fibrosis. TRIAL REGISTRATION NCT02044523 KEY POINTS: • The technical failure rate was similar between MRE and US-based elastography techniques. • Liver stiffness measured by MRE and US-based elastography techniques increased with fibrosis stages and inflammation and decreased with steatosis. • MRE provided a diagnostic accuracy higher than US-based elastography techniques for staging of early stages of histology-determined liver fibrosis.
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Affiliation(s)
- Thierry Lefebvre
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada.,Medical Physics Unit, McGill University, Montreal, Canada
| | - Claire Wartelle-Bladou
- Department of Medicine, Division of Hepatology and Liver Transplantation, Université de Montréal, Montreal, Canada
| | - Philip Wong
- Department of Medicine, Division of Gastroenterology and Hepatology, McGill University Health Centre (MUHC), Montreal, Canada
| | - Giada Sebastiani
- Department of Medicine, Division of Gastroenterology and Hepatology, McGill University Health Centre (MUHC), Montreal, Canada
| | - Jeanne-Marie Giard
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada.,Department of Medicine, Division of Hepatology and Liver Transplantation, Université de Montréal, Montreal, Canada
| | - Hélène Castel
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada.,Department of Medicine, Division of Hepatology and Liver Transplantation, Université de Montréal, Montreal, Canada
| | - Jessica Murphy-Lavallée
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Canada
| | - Damien Olivié
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Canada
| | - André Ilinca
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Marie-Pierre Sylvestre
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada.,Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal (ESPUM), Montreal, Canada
| | - Guillaume Gilbert
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Canada.,MR Clinical Science, Philips Healthcare Canada, Markham, Canada
| | - Zu-Hua Gao
- Department of Pathology, McGill University, Montreal, Canada
| | - Bich N Nguyen
- Service of Pathology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Guy Cloutier
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Canada.,Institute of Biomedical Engineering, Université de Montréal, Montreal, Canada.,Laboratory of Biorheology and Medical Ultrasonics (LBUM), Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - An Tang
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Canada. .,Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada. .,Institute of Biomedical Engineering, Université de Montréal, Montreal, Canada.
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28
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Obrzut M, Atamaniuk V, Obrzut B, Ehman R, Cholewa M, Rzucidło M, Pozaruk A, Gutkowski K. Normative values for magnetic resonance elastography-based liver stiffness in a healthy population. Pol Arch Intern Med 2019; 129:321-326. [PMID: 30793705 PMCID: PMC6731548 DOI: 10.20452/pamw.4456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Chronic liver disease resulting in fibrosis, and ultimately cirrhosis, is a significant cause of morbidity and mortality worldwide. None of the conventional imaging techniques are able to detect early fibrosis and compare its grade with the histopathologic scale. Liver biopsy, as the diagnostic standard for liver fibrosis, also has limitations and is not well accepted by patients. Magnetic resonance elastography is a well‑established technique for evaluating liver stiffness and may replace invasive procedures. Detection of liver fibrosis in its early stages, however, requires a detailed knowledge of normal liver stiffness. OBJECTIVES This study aimed to determine normal liver stiffness values in healthy volunteers. PATIENTS AND METHODS A total of 102 volunteers (mean age, 21.6 years; range, 20-28 years) with no history of gastrointestinal, hepatobiliary, or cardiovascular disease were enrolled in the study. Liver stiffness was evaluated by magnetic resonance elastography with a 1.5T clinical magnetic resonance scanner. Images of the induced transverse wave propagation were obtained and converted to tissue stiffness maps (elastograms). RESULTS The mean (SD) liver stiffness for the entire group of volunteers was 2.14 (0.28) kPa (range, 1.37-2.66 kPa). For women, the mean (SD) stiffness value was 2.14 (0.30) kPa (range, 1.37-2.66 kPa), and for men, 2.14 (0.25) kPa (range, 1.54-2.54 kPa). CONCLUSIONS Liver stiffness in a healthy adult cohort did not exceed 2.7 kPa and is not influenced by sex, body mass index, or fat content.
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Affiliation(s)
- Marzanna Obrzut
- Department of Biophysics, Faculty of Mathematics and Natural Sciences, University of Rzeszów, Rzeszów, Poland
| | - Vitaliy Atamaniuk
- Department of Biophysics, Faculty of Mathematics and Natural Sciences, University of Rzeszów, Rzeszów, Poland
| | - Bogdan Obrzut
- Department of Obstetrics and Gynaecology, Provincial Clinical Hospital No 2 in Rzeszow, University of Rzeszów, Rzeszów, Poland
| | - Richard Ehman
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States
| | - Marian Cholewa
- Department of Biophysics, Faculty of Mathematics and Natural Sciences, University of Rzeszów, Rzeszów, Poland
| | - Mateusz Rzucidło
- Department of Gastroenterology and Hepatology with Internal Disease Unit, Teaching Hospital No. 1 in Rzeszów, Rzeszów, Poland
| | - Andrii Pozaruk
- Department of Biophysics, Faculty of Mathematics and Natural Sciences, University of Rzeszów, Rzeszów, Poland,Monash Biomedical Imaging, Monash University, Melbourne, Australia
| | - Krzysztof Gutkowski
- Department of Gastroenterology and Hepatology with Internal Disease Unit, Teaching Hospital No. 1 in Rzeszów, Rzeszów, Poland
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29
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Akkaya HE, Erden A, Kuru Öz D, Ünal S, Erden İ. Magnetic resonance elastography: basic principles, technique, and clinical applications in the liver. ACTA ACUST UNITED AC 2019; 24:328-335. [PMID: 30272563 DOI: 10.5152/dir.2018.18186] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Magnetic resonance elastography (MRE) is a constantly advancing technique for assessment of stiffness of tissues with newer technology and sequences. It is being increasingly used for the assessment of liver fibrosis. In this article, we discuss the advantages of MRE over biopsy and noninvasive methods such as US elastography in the assessment of liver fibrosis. Image acquisition and interpretation of liver MRE is also discussed.
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Affiliation(s)
| | - Ayşe Erden
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Diğdem Kuru Öz
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Sena Ünal
- Department of Radiology, Erzurum Local Training and Research Hospital, Erzurum, Turkey
| | - İlhan Erden
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
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30
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Abstract
The first clinical application of magnetic resonance elastography (MRE) was in the evaluation of chronic liver disease (CLD) for detection and staging of liver fibrosis. In the past 10 years, MRE has been incorporated seamlessly into a standard magnetic resonance imaging (MRI) liver protocol worldwide. Liver MRE is a robust technique for evaluation of liver stiffness and is currently the most accurate noninvasive imaging technology for evaluation of liver fibrosis. Newer MRE sequences including spin-echo MRE and 3 dimensional MRE have helped in reducing the technical limitations of clinical liver MRE that is performed with 2D gradient recalled echo (GRE) MRE. Advances in MRE technology have led to understanding of newer mechanical parameters such as dispersion, attenuation, and viscoelasticity that may be useful in evaluating pathological processes in CLD and may prove useful in their management.This review article will describe the changes in CLD that cause an increase in stiffness followed by principle and technique of liver MRE. In the later part of the review, we will briefly discuss the advances in liver MRE.
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31
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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: 2.6] [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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32
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Fovargue D, Nordsletten D, Sinkus R. Stiffness reconstruction methods for MR elastography. NMR IN BIOMEDICINE 2018; 31:e3935. [PMID: 29774974 PMCID: PMC6175248 DOI: 10.1002/nbm.3935] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 03/27/2018] [Accepted: 03/27/2018] [Indexed: 05/19/2023]
Abstract
Assessment of tissue stiffness is desirable for clinicians and researchers, as it is well established that pathophysiological mechanisms often alter the structural properties of tissue. Magnetic resonance elastography (MRE) provides an avenue for measuring tissue stiffness and has a long history of clinical application, including staging liver fibrosis and stratifying breast cancer malignancy. A vital component of MRE consists of the reconstruction algorithms used to derive stiffness from wave-motion images by solving inverse problems. A large range of reconstruction methods have been presented in the literature, with differing computational expense, required user input, underlying physical assumptions, and techniques for numerical evaluation. These differences, in turn, have led to varying accuracy, robustness, and ease of use. While most reconstruction techniques have been validated against in silico or in vitro phantoms, performance with real data is often more challenging, stressing the robustness and assumptions of these algorithms. This article reviews many current MRE reconstruction methods and discusses the aforementioned differences. The material assumptions underlying the methods are developed and various approaches for noise reduction, regularization, and numerical discretization are discussed. Reconstruction methods are categorized by inversion type, underlying assumptions, and their use in human and animal studies. Future directions, such as alternative material assumptions, are also discussed.
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Affiliation(s)
- Daniel Fovargue
- Imaging Sciences & Biomedical EngineeringKing's College LondonLondonUK
| | - David Nordsletten
- Imaging Sciences & Biomedical EngineeringKing's College LondonLondonUK
| | - Ralph Sinkus
- Imaging Sciences & Biomedical EngineeringKing's College LondonLondonUK
- Inserm U1148, LVTSUniversity Paris Diderot, University Paris 13Paris75018France
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33
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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: 1.0] [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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Abstract
Liver stiffness is now a well-established noninvasive biomarker for assessing fibrosis in chronic liver disease. MRI-based and ultrasound-based dynamic elastography techniques have been introduced for assessment of liver stiffness and useful in clinical staging of hepatic fibrosis. Several different elastography techniques are now available with each method having inherent strengths and limitations. The published literature generally indicates that MR elastography has a higher diagnostic performance and fewer technical failures than ultrasound-based elastography techniques in assessing hepatic fibrosis. There is also significant potential to further develop elastography techniques to implement multiparametric methods that have promise for distinguishing between processes such as inflammation, fibrosis, venous congestion, and portal hypertension that can result in increased liver stiffness. In this commentary, we compare MR and ultrasound elastography methods and their utility in clinical practice.
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Wang K, Manning P, Szeverenyi N, Wolfson T, Hamilton G, Middleton MS, Vaida F, Yin M, Glaser K, Ehman RL, Sirlin CB. Repeatability and reproducibility of 2D and 3D hepatic MR elastography with rigid and flexible drivers at end-expiration and end-inspiration in healthy volunteers. Abdom Radiol (NY) 2017; 42:2843-2854. [PMID: 28612163 DOI: 10.1007/s00261-017-1206-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To evaluate the repeatability and reproducibility of 2D and 3D hepatic MRE with rigid and flexible drivers at end-expiration and end-inspiration in healthy volunteers. MATERIALS AND METHODS Nine healthy volunteers underwent two same-day MRE exams separated by a 5- to 10-min break. In each exam, 2D and 3D MRE scans were performed, each under four conditions (2 driver types [rigid, flexible] × 2 breath-hold phases [end-expiration, end-inspiration]). Repeatability (measurements under identical conditions) and reproducibility (measurements under different conditions) were analyzed by calculating bias, limit of agreement, repeatability coefficient (RC), reproducibility coefficient (RDC), intraclass correlation coefficient (ICC), and concordance correlation coefficient (CCC), as appropriate. RESULTS For 2D MRE, RCs and ICCs range between 0.29-0.49 and 0.71-0.91, respectively. For 3D MRE, RCs and ICCs range between 0.16-0.26 and 0.84-0.96, respectively. Stiffness values were biased by breath-hold phase, being higher at end-inspiration than end-expiration, and the differences were significant for 3D MRE (p < 0.01). No bias was found between driver types. Inspiration vs. expiration RDCs and CCCs ranged between 0.30-0.54 and 0.61-0.72, respectively. Rigid vs. flexible driver RDCs and CCCs ranged between 0.10-0.44 and 0.79-0.94, respectively. CONCLUSION This preliminary study suggests that 2D MRE and 3D MRE under most conditions potentially have good repeatability. Our result also points to the possibility that stiffness measured with the rigid and flexible drivers is reproducible. Reproducibility between breath-hold phases was modest, suggesting breath-hold phase might be a confounding factor in MRE-based stiffness measurement. However, larger studies are required to validate these preliminary results.
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Costa-Silva L, Ferolla SM, Lima AS, Vidigal PVT, Ferrari TCDA. MR elastography is effective for the non-invasive evaluation of fibrosis and necroinflammatory activity in patients with nonalcoholic fatty liver disease. Eur J Radiol 2017; 98:82-89. [PMID: 29279175 DOI: 10.1016/j.ejrad.2017.11.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To evaluate the performance of magnetic resonance elastography (MRE) in diagnosing and staging hepatic fibrosis in patients with histologically confirmed nonalcoholic fatty liver disease (NAFLD) and in distinguishing simple steatosis from nonalcoholic steatohepatitis (NASH). METHODS Ninety subjects (49 NAFLD patients and 41 healthy volunteers) were prospectively enrolled. Liver stiffness measured by MRE was correlated with the grade of fibrosis and/or inflammation determined by liver biopsy. Correlations, ROC (receiver operator characteristic) curves and diagnostic performance were evaluated. The study was approved by the local ethics committee. RESULTS The area under the ROC curve (AUROC) of MRE in discriminating healthy from NAFLD individuals was 0.964 (P<0.0001), and that for distinguishing advanced (F3-F4) from absent/mild fibrosis (F0-F2) was 0.928 (P<0.0001). The use of a threshold >4.39 kPa resulted in a sensitivity of 90.9% and a specificity of 97.3% for diagnosing advanced fibrosis. For discriminating NASH from simple steatosis, the AUROC was 0.783 (P<0.0001), and the threshold, 3.22 kPa. CONCLUSIONS MRE is an effective, non-invasive method for detecting/staging hepatic fibrosis in NAFLD. This method has good performance in discriminating normal from NAFLD subjects and between the extreme grades of fibrosis. NAFLD patients with inflammation and without fibrosis have higher liver stiffness than those with simple steatosis.
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Affiliation(s)
- Luciana Costa-Silva
- Departmento de Anatomia e Imagem, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Av. Professor Alfredo Balena 190, 30130-100, Belo Horizonte, Minas Gerais, Brazil; Instituto Hermes Pardini, Rua dos Aimorés 66, 30140-070, Belo Horizonte, Minas Gerais, Brazil.
| | - Silvia Marinho Ferolla
- Instituto Alfa de Gastroenterologia, Hospital das Clínicas, UFMG, Av. Professor Alfredo Balena, 110, 30130-100, Belo Horizonte, Minas Gerais, Brazil.
| | - Agnaldo Soares Lima
- Instituto Alfa de Gastroenterologia, Hospital das Clínicas, UFMG, Av. Professor Alfredo Balena, 110, 30130-100, Belo Horizonte, Minas Gerais, Brazil; Departmento de Cirurgia, Faculdade de Medicina, UFMG, Av. Professor Alfredo Balena, 190, 30130-100, Belo Horizonte, Minas Gerais, Brazil.
| | - Paula Vieira Teixeira Vidigal
- Departmento de Anatomia Patológica e Medicina Legal, Faculdade de Medicina, UFMG, Av. Professor Alfredo Balena, 190, 30130-100, Belo Horizonte, Minas Gerais, Brazil.
| | - Teresa Cristina de Abreu Ferrari
- Instituto Alfa de Gastroenterologia, Hospital das Clínicas, UFMG, Av. Professor Alfredo Balena, 110, 30130-100, Belo Horizonte, Minas Gerais, Brazil; Departmento de Clínica Médica, Faculdade de Medicina, UFMG, Av. Professor Alfredo Balena, 190, 30130-100, Belo Horizonte, Minas Gerais, Brazil.
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Morisaka H, Motosugi U, Ichikawa S, Nakazawa T, Kondo T, Funayama S, Matsuda M, Ichikawa T, Onishi H. Magnetic resonance elastography is as accurate as liver biopsy for liver fibrosis staging. J Magn Reson Imaging 2017; 47:1268-1275. [PMID: 29030995 DOI: 10.1002/jmri.25868] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 09/19/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Liver MR elastography (MRE) is available for the noninvasive assessment of liver fibrosis; however, no previous studies have compared the diagnostic ability of MRE with that of liver biopsy. PURPOSE To compare the diagnostic accuracy of liver fibrosis staging between MRE-based methods and liver biopsy using the resected liver specimens as the reference standard. STUDY TYPE A retrospective study at a single institution. POPULATION In all, 200 patients who underwent preoperative MRE and subsequent surgical liver resection were included in this study. Data from 80 patients were used to estimate cutoff and distributions of liver stiffness values measured by MRE for each liver fibrosis stage (F0-F4, METAVIR system). In the remaining 120 patients, liver biopsy specimens were obtained from the resected liver tissues using a standard biopsy needle. FIELD STRENGTH/SEQUENCE 2D liver MRE with gradient-echo based sequence on a 1.5 or 3T scanner was used. ASSESSMENT Two radiologists independently measured the liver stiffness value on MRE and two types of MRE-based methods (threshold and Bayesian prediction method) were applied. Two pathologists evaluated all biopsy samples independently to stage liver fibrosis. Surgically resected whole tissue specimens were used as the reference standard. STATISTICAL TESTS The accuracy for liver fibrosis staging was compared between liver biopsy and MRE-based methods with a modified McNemar's test. RESULTS Accurate fibrosis staging was achieved in 53.3% (64/120) and 59.1% (71/120) of patients using MRE with threshold and Bayesian methods, respectively, and in 51.6% (62/120) with liver biopsy. Accuracies of MRE-based methods for diagnoses of ≥F2 (90-91% [108-9/120]), ≥F3 (79-81% [95-97/120]), and F4 (82-85% [98-102/120]) were statistically equivalent to those of liver biopsy (≥F2, 79% [95/120], P ≤ 0.01; ≥F3, 88% [105/120], P ≤ 0.006; and F4, 82% [99/120], P ≤ 0.017). DATA CONCLUSION MRE can be an alternative to liver biopsy for fibrosis staging. LEVEL OF EVIDENCE 3. Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1268-1275.
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Affiliation(s)
- Hiroyuki Morisaka
- Department of Radiology, University of Yamanashi, Yamanashi, Japan.,Diagnostic Radiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Utaroh Motosugi
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | | | - Tadao Nakazawa
- Department of Pathology, University of Yamanashi, Yamanashi, Japan
| | - Tetsuo Kondo
- Department of Pathology, University of Yamanashi, Yamanashi, Japan
| | - Satoshi Funayama
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Masanori Matsuda
- Department of Gastrointestinal Surgery, University of Yamanashi, Yamanashi, Japan
| | - Tomoaki Ichikawa
- Diagnostic Radiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
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Cheah MCC, McCullough AJ, Goh GBB. Current Modalities of Fibrosis Assessment in Non-alcoholic Fatty Liver Disease. J Clin Transl Hepatol 2017; 5:261-271. [PMID: 28936407 PMCID: PMC5606972 DOI: 10.14218/jcth.2017.00009] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 04/13/2017] [Accepted: 04/29/2017] [Indexed: 12/12/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a burgeoning global health concern. In the subset of NAFLD patients with non-alcoholic steatohepatitis (NASH), the presence of significant fibrosis at index assessment is associated with poor prognosis and increased mortality. Hence, there is a growing need to accurately assess and stage fibrosis. Liver biopsy, the current gold standard, has limitations with sampling error and is invasive, with associated inherent risk. This has led to a host of non-invasive means of assessing fibrosis, which has garnered relevance in a disease that requires serial assessment of fibrosis longitudinally over time. This review discusses, comprehensively, the various tools available to the clinician for the assessment of fibrosis, including the various scoring systems used in liver biopsy, the non-invasive means of serum biomarkers, such as the highly-validated NAFLD fibrosis score, and the imaging-based modalities, such as transient elastography and magnetic resonance elastography.
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Affiliation(s)
- Mark CC Cheah
- Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore
| | - Arthur J McCullough
- Department of Gastroenterology, Cleveland Clinic, Ohio, USA
- Department of Pathobiology, Cleveland Clinic, Ohio, USA
| | - George Boon-Bee Goh
- Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
- *Correspondence to: Dr George Boon-Bee Goh, Department of Gastroenterology & Hepatology, Singapore General Hospital, 20 College Road, Singapore 169856, Singapore. Tel: +65-62223322, Fax: +65-62273623, E-mail:
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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: 102] [Impact Index Per Article: 12.8] [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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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: 94] [Impact Index Per Article: 11.8] [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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Kazemirad S, Zhang E, Nguyen BN, Bodson-Clermont P, Destrempes F, Trudel D, Cloutier G, Tang A. Detection of Steatohepatitis in a Rat Model by Using Spectroscopic Shear-Wave US Elastography. Radiology 2017; 282:726-733. [PMID: 27513850 DOI: 10.1148/radiol.2016160308] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Abstract
Purpose To compare low- versus high-frequency ultrasonographic (US) elastography for detection of steatohepatitis in rats by using histopathologic findings as the reference standard. Materials and Methods Between March and September 2014, after receiving approval from the institutional animal care committee, 60 male Sprague-Dawley rats were fed either a standard chow for 4 weeks or a methionine- and choline-deficient diet for 1, 4, 8, or 12 weeks to induce a continuum of steatohepatitis severity. Liver shear stiffness was assessed in vivo by using US elastography at low (40-130-Hz) and high (130-220-Hz) frequencies. Histologic features (steatosis, inflammation, and fibrosis) and modified nonalcoholic steatohepatitis categories were used as reference standards. Definite steatohepatitis was divided into steatohepatitis with fibrosis stage 1 or lower and stage 2 and higher. Analyses included the Kendall τ correlation, multivariable linear regression analyses, Kruskal-Wallis rank sum test, and post hoc Dunn test with Holm correction. Results Correlations between liver shear stiffness and histologic features were higher at high frequencies than at low frequencies (low frequency: 0.08, 0.24, and 0.20 for steatosis, inflammation, and fibrosis, respectively; high frequency: 0.11, 0.35, and 0.50, respectively). The absolute value of multivariable regression coefficients was higher at high frequencies for the presence of steatosis, inflammation grade, and fibrosis stage (low frequency: -0.475, 0.157, and 0.209, respectively; high frequency: -0.893, 0.357, and 0.447, respectively). The model fit was better at high frequencies (adjusted R2 = 0.57) than at low frequencies (adjusted R2 = 0.21). There was a significant difference between steatohepatitis categories at both low and high frequencies (P = .022 and P < .001, respectively). Conclusion Liver shear stiffness measured with US elastography provided better distinction of steatohepatitis categories at high frequencies than at low frequencies. Further, liver shear stiffness decreased with steatosis and increased with inflammation and fibrosis at both low and high frequencies. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Siavash Kazemirad
- From the Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada (S.K., E.Z., P.B.C., F.D., D.T., G.C., A.T.); Laboratory of Biorheology and Medical Ultrasonics (LBUM), Montreal, Quebec, Canada (S.K., E.Z., F.D., G.C.); Dept of Pathology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (B.N.N., D.T.); Dept of Pathology and Cellular Biology, Université de Montréal, Montreal, Quebec, Canada (B.N.N., D.T.); Inst of Biomedical Engineering, Université de Montréal, Montreal, Quebec, Canada (G.C.); and Dept of Radiology, Radio-oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4 (G.C., A.T.)
| | - Eric Zhang
- From the Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada (S.K., E.Z., P.B.C., F.D., D.T., G.C., A.T.); Laboratory of Biorheology and Medical Ultrasonics (LBUM), Montreal, Quebec, Canada (S.K., E.Z., F.D., G.C.); Dept of Pathology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (B.N.N., D.T.); Dept of Pathology and Cellular Biology, Université de Montréal, Montreal, Quebec, Canada (B.N.N., D.T.); Inst of Biomedical Engineering, Université de Montréal, Montreal, Quebec, Canada (G.C.); and Dept of Radiology, Radio-oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4 (G.C., A.T.)
| | - Bich N Nguyen
- From the Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada (S.K., E.Z., P.B.C., F.D., D.T., G.C., A.T.); Laboratory of Biorheology and Medical Ultrasonics (LBUM), Montreal, Quebec, Canada (S.K., E.Z., F.D., G.C.); Dept of Pathology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (B.N.N., D.T.); Dept of Pathology and Cellular Biology, Université de Montréal, Montreal, Quebec, Canada (B.N.N., D.T.); Inst of Biomedical Engineering, Université de Montréal, Montreal, Quebec, Canada (G.C.); and Dept of Radiology, Radio-oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4 (G.C., A.T.)
| | - Paule Bodson-Clermont
- From the Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada (S.K., E.Z., P.B.C., F.D., D.T., G.C., A.T.); Laboratory of Biorheology and Medical Ultrasonics (LBUM), Montreal, Quebec, Canada (S.K., E.Z., F.D., G.C.); Dept of Pathology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (B.N.N., D.T.); Dept of Pathology and Cellular Biology, Université de Montréal, Montreal, Quebec, Canada (B.N.N., D.T.); Inst of Biomedical Engineering, Université de Montréal, Montreal, Quebec, Canada (G.C.); and Dept of Radiology, Radio-oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4 (G.C., A.T.)
| | - François Destrempes
- From the Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada (S.K., E.Z., P.B.C., F.D., D.T., G.C., A.T.); Laboratory of Biorheology and Medical Ultrasonics (LBUM), Montreal, Quebec, Canada (S.K., E.Z., F.D., G.C.); Dept of Pathology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (B.N.N., D.T.); Dept of Pathology and Cellular Biology, Université de Montréal, Montreal, Quebec, Canada (B.N.N., D.T.); Inst of Biomedical Engineering, Université de Montréal, Montreal, Quebec, Canada (G.C.); and Dept of Radiology, Radio-oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4 (G.C., A.T.)
| | - Dominique Trudel
- From the Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada (S.K., E.Z., P.B.C., F.D., D.T., G.C., A.T.); Laboratory of Biorheology and Medical Ultrasonics (LBUM), Montreal, Quebec, Canada (S.K., E.Z., F.D., G.C.); Dept of Pathology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (B.N.N., D.T.); Dept of Pathology and Cellular Biology, Université de Montréal, Montreal, Quebec, Canada (B.N.N., D.T.); Inst of Biomedical Engineering, Université de Montréal, Montreal, Quebec, Canada (G.C.); and Dept of Radiology, Radio-oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4 (G.C., A.T.)
| | - Guy Cloutier
- From the Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada (S.K., E.Z., P.B.C., F.D., D.T., G.C., A.T.); Laboratory of Biorheology and Medical Ultrasonics (LBUM), Montreal, Quebec, Canada (S.K., E.Z., F.D., G.C.); Dept of Pathology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (B.N.N., D.T.); Dept of Pathology and Cellular Biology, Université de Montréal, Montreal, Quebec, Canada (B.N.N., D.T.); Inst of Biomedical Engineering, Université de Montréal, Montreal, Quebec, Canada (G.C.); and Dept of Radiology, Radio-oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4 (G.C., A.T.)
| | - An Tang
- From the Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada (S.K., E.Z., P.B.C., F.D., D.T., G.C., A.T.); Laboratory of Biorheology and Medical Ultrasonics (LBUM), Montreal, Quebec, Canada (S.K., E.Z., F.D., G.C.); Dept of Pathology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada (B.N.N., D.T.); Dept of Pathology and Cellular Biology, Université de Montréal, Montreal, Quebec, Canada (B.N.N., D.T.); Inst of Biomedical Engineering, Université de Montréal, Montreal, Quebec, Canada (G.C.); and Dept of Radiology, Radio-oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4 (G.C., A.T.)
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Stoopen-Rometti M, Encinas-Escobar ER, Ramirez-Carmona CR, Wolpert-Barraza E, Kimura-Hayama E, Sosa-Lozano LA, Favila R, Kimura-Fujikami Y, Saavedra-Abril JA, Loaeza-Del Castillo A. Diagnosis and quantification of fibrosis, steatosis, and hepatic siderosis through multiparametric magnetic resonance imaging. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2017; 82:32-45. [PMID: 28089429 DOI: 10.1016/j.rgmx.2016.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 05/31/2016] [Accepted: 06/16/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND The presence of liver fibrosis is the common denominator in numerous chronic liver diseases that can progress to fibrosis and hepatocellular carcinoma. Most important, with respect to frequency, are viral hepatitis and non-alcoholic fatty liver disease, the prevalence of which is increasing in epidemic proportions. Liver biopsy, albeit imperfect, continues to be the criterion standard, but in many clinical situations tends to be replaced with noninvasive imaging methods. OBJECTIVES The aim of the present article was to describe our imaging department experience with magnetic resonance elastography and to analyze and discuss recently published results in gastroenterology, hepatology, and radiology from other authors in the literature, complemented with a PubMed search covering the last 10 years. RESULTS AND CONCLUSIONS Magnetic resonance elastography is an efficacious, noninvasive method with results that are concordant with liver biopsy. It is superior to ultrasound elastography because it evaluates a much greater volume of hepatic tissue and shows the often heterogeneous lesion distribution. The greatest advantage of the magnetic resonance protocol described is the fact that it quantifies fibrosis, fat content, and iron content in the same 25min examination specifically directed for that purpose, resulting in a favorable cost-benefit ratio for the patient and/or institution.
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Affiliation(s)
- M Stoopen-Rometti
- Departamento de Imagen, C.T. Scanner Lomas Altas, Ciudad de México, México.
| | - E R Encinas-Escobar
- Curso Universitario de Radiología, C.T. Scanner, Instituto Nacional de Cardiología Ignacio Chávez, Universidad Nacional Autónoma de México, Ciudad de México, México
| | | | - E Wolpert-Barraza
- Unidad de Gastroenterología y Hepatología, Clínica Lomas Altas, Ciudad de México, México
| | - E Kimura-Hayama
- Departamento de Imagen, C.T. Scanner Lomas Altas, Ciudad de México, México
| | - L A Sosa-Lozano
- Departamento de Imagen, C.T. Scanner de México, Ciudad de México, México
| | - R Favila
- General Electric Healthcare, Durango, México
| | - Y Kimura-Fujikami
- Departamento de Imagen, C.T. Scanner de México, Ciudad de México, México
| | - J A Saavedra-Abril
- Departamento de Imagen, C.T. Scanner Lomas Altas, Ciudad de México, México
| | - A Loaeza-Del Castillo
- Unidad de Gastroenterología y Hepatología, Clínica Lomas Altas, Ciudad de México, México
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Stoopen-Rometti M, Encinas-Escobar E, Ramirez-Carmona C, Wolpert-Barraza E, Kimura-Hayama E, Sosa-Lozano L, Favila R, Kimura-Fujikami Y, Saavedra-Abril J, Loaeza-del Castillo A. Diagnosis and quantification of fibrosis, steatosis, and hepatic siderosis through multiparametric magnetic resonance imaging. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2017. [DOI: 10.1016/j.rgmxen.2017.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Srinivasa Babu A, Wells ML, Teytelboym OM, Mackey JE, Miller FH, Yeh BM, Ehman RL, Venkatesh SK. Elastography in Chronic Liver Disease: Modalities, Techniques, Limitations, and Future Directions. Radiographics 2016; 36:1987-2006. [PMID: 27689833 DOI: 10.1148/rg.2016160042] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Chronic liver disease has multiple causes, many of which are increasing in prevalence. The final common pathway of chronic liver disease is tissue destruction and attempted regeneration, a pathway that triggers fibrosis and eventual cirrhosis. Assessment of fibrosis is important not only for diagnosis but also for management, prognostic evaluation, and follow-up of patients with chronic liver disease. Although liver biopsy has traditionally been considered the reference standard for assessment of liver fibrosis, noninvasive techniques are the emerging focus in this field. Ultrasound-based elastography and magnetic resonance (MR) elastography are gaining popularity as the modalities of choice for quantifying hepatic fibrosis. These techniques have been proven superior to conventional cross-sectional imaging for evaluation of fibrosis, especially in the precirrhotic stages. Moreover, elastography has added utility in the follow-up of previously diagnosed fibrosis, the assessment of treatment response, evaluation for the presence of portal hypertension (spleen elastography), and evaluation of patients with unexplained portal hypertension. In this article, a brief overview is provided of chronic liver disease and the tools used for its diagnosis. Ultrasound-based elastography and MR elastography are explored in depth, including a brief glimpse into the evolution of elastography. Elastography is based on the principle of measuring tissue response to a known mechanical stimulus. Specific elastographic techniques used to exploit this principle include MR elastography and ultrasonography-based static or quasistatic strain imaging, one-dimensional transient elastography, point shear-wave elastography, and supersonic shear-wave elastography. The advantages, limitations, and pitfalls of each modality are emphasized. ©RSNA, 2016.
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Affiliation(s)
- Aparna Srinivasa Babu
- From the Departments of Radiology of Mercy Catholic Medical Center, Darby, Pa (A.S.B., O.M.T., J.E.M.); Mayo Clinic, 200 First St SW, Rochester, MN 55905 (M.L.W., R.L.E., S.K.V.); Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); and University of California-San Francisco School of Medicine, San Francisco, Calif (B.M.Y.)
| | - Michael L Wells
- From the Departments of Radiology of Mercy Catholic Medical Center, Darby, Pa (A.S.B., O.M.T., J.E.M.); Mayo Clinic, 200 First St SW, Rochester, MN 55905 (M.L.W., R.L.E., S.K.V.); Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); and University of California-San Francisco School of Medicine, San Francisco, Calif (B.M.Y.)
| | - Oleg M Teytelboym
- From the Departments of Radiology of Mercy Catholic Medical Center, Darby, Pa (A.S.B., O.M.T., J.E.M.); Mayo Clinic, 200 First St SW, Rochester, MN 55905 (M.L.W., R.L.E., S.K.V.); Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); and University of California-San Francisco School of Medicine, San Francisco, Calif (B.M.Y.)
| | - Justin E Mackey
- From the Departments of Radiology of Mercy Catholic Medical Center, Darby, Pa (A.S.B., O.M.T., J.E.M.); Mayo Clinic, 200 First St SW, Rochester, MN 55905 (M.L.W., R.L.E., S.K.V.); Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); and University of California-San Francisco School of Medicine, San Francisco, Calif (B.M.Y.)
| | - Frank H Miller
- From the Departments of Radiology of Mercy Catholic Medical Center, Darby, Pa (A.S.B., O.M.T., J.E.M.); Mayo Clinic, 200 First St SW, Rochester, MN 55905 (M.L.W., R.L.E., S.K.V.); Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); and University of California-San Francisco School of Medicine, San Francisco, Calif (B.M.Y.)
| | - Benjamin M Yeh
- From the Departments of Radiology of Mercy Catholic Medical Center, Darby, Pa (A.S.B., O.M.T., J.E.M.); Mayo Clinic, 200 First St SW, Rochester, MN 55905 (M.L.W., R.L.E., S.K.V.); Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); and University of California-San Francisco School of Medicine, San Francisco, Calif (B.M.Y.)
| | - Richard L Ehman
- From the Departments of Radiology of Mercy Catholic Medical Center, Darby, Pa (A.S.B., O.M.T., J.E.M.); Mayo Clinic, 200 First St SW, Rochester, MN 55905 (M.L.W., R.L.E., S.K.V.); Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); and University of California-San Francisco School of Medicine, San Francisco, Calif (B.M.Y.)
| | - Sudhakar K Venkatesh
- From the Departments of Radiology of Mercy Catholic Medical Center, Darby, Pa (A.S.B., O.M.T., J.E.M.); Mayo Clinic, 200 First St SW, Rochester, MN 55905 (M.L.W., R.L.E., S.K.V.); Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); and University of California-San Francisco School of Medicine, San Francisco, Calif (B.M.Y.)
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Morisaka H, Motosugi U, Glaser KJ, Ichikawa S, Ehman RL, Sano K, Ichikawa T, Onishi H. Comparison of diagnostic accuracies of two- and three-dimensional MR elastography of the liver. J Magn Reson Imaging 2016; 45:1163-1170. [PMID: 27662640 DOI: 10.1002/jmri.25425] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 08/02/2016] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To evaluate the effect of imaging sequence (spin-echo echo-planar imaging [EPI] and gradient-echo [GRE]) and postprocessing method (two-dimensional [2D] and 3D inversion algorithms) on liver MR elastography (MRE) and to validate the diagnostic performance of EPI-MRE3D versus conventional GRE-MRE2D for liver fibrosis staging. MATERIALS AND METHODS Three MRE methods (EPI-MRE3D , EPI-MRE2D , and GRE-MRE2D ) were performed on soft and mildly stiff phantoms and 58 patients with chronic liver disease using a 3 Tesla clinical MRI scanner, and stiffness values were compared among the three methods. A validation study comprised 73 patients with histological liver fibrosis (F0-4, METAVIR system). Areas under the receiver operating characteristic curves (AUCs) and accuracies for diagnosing significant fibrosis (F3-4) and cirrhosis (F4) were compared between EPI-MRE3D and GRE-MRE2D . RESULTS Stiffness values of the soft and mildly stiff phantoms were 2.4 kPa and 4.0 kPa by EPI-MRE3D ; 2.6 kPa and 4.2 kPa by EPI-MRE2D ; and 2.7 kPa and 4.2 kPa by GRE-MRE2D . In patients, EPI-MRE3D provided significantly lower stiffness values than other methods (P < 0.001). However, there was no significant difference between GRE-MRE2D and EPI-MRE2D (P = 0.12). The AUCs and accuracies of EPI-MRE3D and GRE-MRE2D were statistically equivalent in the diagnoses of significant fibrosis (F3-4) and cirrhosis (F4) (all P < 0.005). CONCLUSION EPI-MRE3D showed modestly lower liver stiffness values than conventional GRE-MRE2D . The diagnostic performances of EPI-MRE3D and GRE-MRE2D were equivalent for liver fibrosis staging. LEVEL OF EVIDENCE 3 J. Magn. Reson. Imaging 2017;45:1163-1170.
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Affiliation(s)
- Hiroyuki Morisaka
- Department of Radiology, University of Yamanashi, Yamanashi, Japan.,Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Utaroh Motosugi
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Kevin J Glaser
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Richard L Ehman
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Katsuhiro Sano
- Department of Radiology, University of Yamanashi, Yamanashi, Japan.,Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Tomoaki Ichikawa
- Department of Radiology, University of Yamanashi, Yamanashi, Japan.,Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
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Lizaola B, Bonder A, Tapper EB, Afdhal N. Role of Noninvasive Fibrosis Methods in Management of Chronic Hepatitis B Virus. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s11901-016-0311-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Abstract
Over the past decade, several advances have been made in the non-invasive assessment of liver fibrosis. Both serum markers and imaging-based tissue elastography predict the presence of advanced fibrosis compared with liver biopsy. Serum markers may be indirect or direct markers of liver structure and function. Imaging-based techniques measure liver stiffness as a surrogate for fibrosis and include ultrasound and MRI-based methods. Most non-invasive techniques work well at identifying subjects at the extremes of fibrosis but may not accurately discern intermediate stages. In addition to being a diagnostic tool, elastography may have an evolving role in prognosis. Increasing stiffness is associated with higher rates of liver decompensation, need for transplantation, hepatocellular carcinoma, and death. There are special populations of patients where elastography may serve as a non-invasive method to impart useful clinical information, such as patients after liver transplantation, those with congenital heart disease and those being treated for chronic viral hepatitis. The role of non-invasive markers in accurately predicting the presence of fibrosis in obese patients needs to be further refined.
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Affiliation(s)
- Michael Hagan
- a 1 Baylor University Medical Center, Dallas, TX, USA
| | | | - Jayant Talwalkar
- b 2 Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA
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Saito S, Tanaka K, Hashido T. Magnetic Resonance Elastography: Measurement of Hepatic Stiffness Using Different Direct Inverse Problem Reconstruction Methods in Healthy Volunteers and Patients with Liver Disease. Nihon Hoshasen Gijutsu Gakkai Zasshi 2016; 72:128-38. [PMID: 26902377 DOI: 10.6009/jjrt.2016_jsrt_72.2.128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this study was to compare the mean hepatic stiffness values obtained by the application of two different direct inverse problem reconstruction methods to magnetic resonance elastography (MRE). Thirteen healthy men (23.2±2.1 years) and 16 patients with liver diseases (78.9±4.3 years; 12 men and 4 women) were examined for this study using a 3.0 T-MRI. The healthy volunteers underwent three consecutive scans, two 70-Hz waveform and a 50-Hz waveform scans. On the other hand, the patients with liver disease underwent scanning using the 70-Hz waveform only. The MRE data for each subject was processed twice for calculation of the mean hepatic stiffness (Pa), once using the multiscale direct inversion (MSDI) and once using the multimodel direct inversion (MMDI). There were no significant differences in the mean stiffness values among the scans obtained with two 70-Hz and different waveforms. However, the mean stiffness values obtained with the MSDI technique (with mask: 2895.3±255.8 Pa, without mask: 2940.6±265.4 Pa) were larger than those obtained with the MMDI technique (with mask: 2614.0±242.1 Pa, without mask: 2699.2±273.5 Pa). The reproducibility of measurements obtained using the two techniques was high for both the healthy volunteers [intraclass correlation coefficients (ICCs): 0.840-0.953] and the patients (ICC: 0.830-0.995). These results suggest that knowledge of the characteristics of different direct inversion algorithms is important for longitudinal liver stiffness assessments such as the comparison of different scanners and evaluation of the response to fibrosis therapy.
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Affiliation(s)
- Shigeyoshi Saito
- Department of Medical Physics and Engineering, Division of Health Sciences, Osaka University, Graduate School of Medicine
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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: 69] [Impact Index Per Article: 7.7] [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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Rusak G, Zawada E, Lemanowicz A, Serafin Z. Whole-organ and segmental stiffness measured with liver magnetic resonance elastography in healthy adults: significance of the region of interest. ACTA ACUST UNITED AC 2015; 40:776-82. [PMID: 25331569 PMCID: PMC4372679 DOI: 10.1007/s00261-014-0278-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE MR elastography (MRE) is a recent non-invasive technique that provides in vivo data on the viscoelasticity of the liver. Since the method is not well established, several different protocols were proposed that differ in results. The aim of the study was to analyze the variability of stiffness measurements in different regions of the liver. METHODS Twenty healthy adults aged 24-45 years were recruited. The examination was performed using a mechanical excitation of 64 Hz. MRE images were fused with axial T2WI breath-hold images (thickness 10 mm, spacing 10 mm). Stiffness was measured as a mean value of each cross section of the whole liver, on a single largest cross section, in the right lobe, and in ROIs (50 pix.) placed in the center of the left lobe, segments 5/6, 7, 8, and the parahilar region. RESULTS Whole-liver stiffness ranged from 1.56 to 2.75 kPa. Mean segmental stiffness differed significantly between the tested regions (range from 1.55 ± 0.28 to 2.37 ± 0.32 kPa; P < 0.0001, ANOVA). Within-method variability of measurements ranged from 14 % for whole liver and segment 8-26 % for segment 7. Within-subject variability ranged from 13 to 31 %. Results of measurement within segment 8 were closest to the whole-liver method (ICC, 0.84). CONCLUSIONS Stiffness of the liver presented significant variability depending on the region of measurement. The most reproducible method is averaging of cross sections of the whole liver. There was significant variability between stiffness in subjects considered healthy, which requires further investigation.
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Affiliation(s)
- Grażyna Rusak
- Department of Radiology and Diagnostic Imaging, Nicolaus Copernicus University, Collegium Medicum, ul. Skłodowskiej-Curie 9, 85-094, Bydgoszcz, Poland
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