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Ishihara Y, Numano T, Ito D, Nishijo H, Takamoto K, Kikuchi J, Konuma S, Oka H. Development of a suitable vibration pad for renal MR elastography. Magn Reson Imaging 2024; 109:120-126. [PMID: 38492785 DOI: 10.1016/j.mri.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/04/2024] [Accepted: 03/13/2024] [Indexed: 03/18/2024]
Abstract
The aim of this study was to develop a vibration pad suitable for renal MR elastography (MRE). Chronic kidney disease (CKD) is a progressive condition affecting >800 million people worldwide. Renal fibrosis is a common pathological feature of CKD that causes fibrotic regions to be much stiffer than those in normal renal tissues. Therefore, MRE can be used to diagnose CKD because it can image organ stiffness. In MRE, the shear modulus is obtained from the wavelength of the shear waves. Therefore, it is highly important to propagate shear waves with sufficient vibration strength in the tissue. By using a three-dimensional (3D) printer, we created a "Flexible Pad" suitable for renal MRE. The Flexible Pad was placed under the back of the participant in the supine position and deformed in response to the participant's weight, adhering closely to the body surface. Six healthy volunteers participated in this study. Our Flexible Pad allowed for coherent shear waves (clear waves with little scattering and interference) to be efficiently transmitted to the kidney deep-lying tissues in the abdomen. The shear moduli of the kidney (n = 6) were 8.95 ± 0.84 kPa in the right kidney and 9.70 ± 0.99 kPa in the left kidney. Our results indicate that using our Flexible Pad for renal MRE can provide a more reliable measurement of renal shear modulus.
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Affiliation(s)
- Yoshito Ishihara
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10, Higashiogu, Arakawa-ku, Tokyo 116-8551, Japan
| | - Tomokazu Numano
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10, Higashiogu, Arakawa-ku, Tokyo 116-8551, Japan.
| | - Daiki Ito
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10, Higashiogu, Arakawa-ku, Tokyo 116-8551, Japan; Office of Radiation Technology, Keio University Hospital, Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Hisao Nishijo
- Department of Sport and Health Sciences, Faculty of Human Sciences, University of East Asia, 2-1, Ichinomiya Gakuen-cho, Shimonoseki-shi, Yamaguchi 751-8503, Japan
| | - Koichi Takamoto
- Department of Sport and Health Sciences, Faculty of Human Sciences, University of East Asia, 2-1, Ichinomiya Gakuen-cho, Shimonoseki-shi, Yamaguchi 751-8503, Japan
| | - Jo Kikuchi
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10, Higashiogu, Arakawa-ku, Tokyo 116-8551, Japan
| | - Shota Konuma
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10, Higashiogu, Arakawa-ku, Tokyo 116-8551, Japan
| | - Hiromu Oka
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10, Higashiogu, Arakawa-ku, Tokyo 116-8551, Japan
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Liu J, Huang M, Zhang Y, Yao F, Zhang X, Yin M, Wang K, Cheng J. Technical Success and Reliability of Magnetic Resonance Elastography in Patients with Hepatic Iron Overload. Acad Radiol 2024; 31:1326-1335. [PMID: 37863778 DOI: 10.1016/j.acra.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/03/2023] [Accepted: 08/14/2023] [Indexed: 10/22/2023]
Abstract
RATIONALE AND OBJECTIVES This study aimed to evaluate the technical success rate and stiffness measurement reliability of two specific hepatic magnetic resonance elastography (MRE) sequences dedicated to solving susceptibility artifacts in patients with various degrees of hepatic iron overload. MATERIALS AND METHODS Thirty-seven patients with iron-overloaded liver confirmed by R2* value measurement who underwent two-dimensional (2D) spin-echo (SE) MRE and 2D SE-echo-planar-imaging (EPI) MRE were reviewed retrospectively. According to four categories based on R2* value (mild, moderate, severe elevation, and extremely severe iron overload), we compared the success rate, quality score, and liver stiffness of the two sequences. In addition, Spearman's correlation was performed to evaluate the relationship between the R2* value and liver stiffness. RESULTS The overall success rates of SE MRE and SE-EPI MRE in patients with hepatic iron overload were 91.89% and 78.38%, respectively, and 100% and 78.57%, respectively, for severe elevation iron overload. In all patients, the MRE quality scores were 54 and 48 for SE MRE and SE-EPI MRE, respectively (P = 0.107). There were no significant differences in liver stiffness measurements between the two MRE methods in patients with mild, moderate, and severe elevation iron-overloaded livers (P > 0.6 for all), respectively. For both MRE methods, R2* value had no significant effect on the liver stiffness measurements (correlation coefficient <0.1, P >0.6 for both). CONCLUSION In the mild and moderate elevation iron-overloaded liver, both SE MRE and fast SE-EPI MRE can provide successful and reliable liver stiffness measurement. In severe elevation iron-overloaded livers, SE MRE may be a better choice than SE-EPI MRE.
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Affiliation(s)
- Jingjing Liu
- Department of MR Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (J.L., M.H., Y.Z., F.Y., X.Z., J.C.).
| | - Mengyue Huang
- Department of MR Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (J.L., M.H., Y.Z., F.Y., X.Z., J.C.)
| | - Yong Zhang
- Department of MR Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (J.L., M.H., Y.Z., F.Y., X.Z., J.C.)
| | - Feifei Yao
- Department of MR Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (J.L., M.H., Y.Z., F.Y., X.Z., J.C.)
| | - Xiaopan Zhang
- Department of MR Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (J.L., M.H., Y.Z., F.Y., X.Z., J.C.)
| | - Meng Yin
- Department of Radiology, Mayo Clinic, Rochester, Minnesota (M.Y.)
| | - Kaiyu Wang
- MR Research China, GE Healthcare, Beijing, PR China (K.W.)
| | - Jingliang Cheng
- Department of MR Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (J.L., M.H., Y.Z., F.Y., X.Z., J.C.)
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Lee HJ, Cho SB, Lee JK, Kim JS, Oh CH, Kim HJ, Yoon H, Ahn HK, Kim M, Hwang YG, Kwon HY, Hwang MJ. The feasibility of MR elastography with transpelvic vibration for localization of focal prostate lesion. Sci Rep 2024; 14:3864. [PMID: 38366042 PMCID: PMC10873507 DOI: 10.1038/s41598-024-54341-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/12/2024] [Indexed: 02/18/2024] Open
Abstract
We aimed to evaluate the feasibility of MR elastography (MRE) using a transpelvic approach. Thirty-one patients who underwent prostate MRE and had a pathological diagnosis were included in this study. MRE was obtained using a passive driver placed at the umbilicus and iliac crests. The shear stiffness, clinical data, and conventional imaging findings of prostate cancer and benign prostatic hyperplasia (BPH) were compared. Inter-reader agreements were evaluated using the intraclass coefficient class (ICC). Prostate MRE was successfully performed for all patients (100% technical success rate). Nineteen cancer and 10 BPH lesions were visualized on MRE. The mean shear stiffness of cancer was significantly higher than that of BPH (5.99 ± 1.46 kPa vs. 4.67 ± 1.54 kPa, p = 0.045). One cancer was detected on MRE but not on conventional sequences. Six tiny cancer lesions were not visualized on MRE. The mean size of cancers that were not detected on MRE was smaller than that of cancers that were visible on MRE (0.8 ± 0.3 cm vs. 2.3 ± 1.8 cm, p = 0.001). The inter-reader agreement for interpreting MRE was excellent (ICC = 0.95). Prostate MRE with transpelvic vibration is feasible without intracavitary actuators. Transpelvic prostate MRE is reliable for detecting focal lesions, including clinically significant prostate cancer and BPH.
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Affiliation(s)
- Hyo Jeong Lee
- Department of Radiology, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Soo Buem Cho
- Department of Radiology, Ewha Womans University College of Medicine, Seoul, South Korea.
| | - Jeong Kyong Lee
- Department of Radiology, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Jin Sil Kim
- Department of Radiology, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Chang Hoon Oh
- Department of Radiology, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Hyun Jin Kim
- Department of Radiology, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Hana Yoon
- Department of Urology, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Hyun Kyu Ahn
- Department of Urology, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Myong Kim
- Department of Urology, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Yeok Gu Hwang
- Department of Orthopedic Surgery, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Hye Young Kwon
- Department of Radiology, Chungnam National University College of Medicine, Daejeon, South Korea
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Peyton SR, Platt MO, Cukierman E. Challenges and Opportunities Modeling the Dynamic Tumor Matrisome. BME FRONTIERS 2023; 4:0006. [PMID: 37849664 PMCID: PMC10521682 DOI: 10.34133/bmef.0006] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 11/28/2022] [Indexed: 10/19/2023] Open
Abstract
We need novel strategies to target the complexity of cancer and, particularly, of metastatic disease. As an example of this complexity, certain tissues are particularly hospitable environments for metastases, whereas others do not contain fertile microenvironments to support cancer cell growth. Continuing evidence that the extracellular matrix (ECM) of tissues is one of a host of factors necessary to support cancer cell growth at both primary and secondary tissue sites is emerging. Research on cancer metastasis has largely been focused on the molecular adaptations of tumor cells in various cytokine and growth factor environments on 2-dimensional tissue culture polystyrene plates. Intravital imaging, conversely, has transformed our ability to watch, in real time, tumor cell invasion, intravasation, extravasation, and growth. Because the interstitial ECM that supports all cells in the tumor microenvironment changes over time scales outside the possible window of typical intravital imaging, bioengineers are continuously developing both simple and sophisticated in vitro controlled environments to study tumor (and other) cell interactions with this matrix. In this perspective, we focus on the cellular unit responsible for upholding the pathologic homeostasis of tumor-bearing organs, cancer-associated fibroblasts (CAFs), and their self-generated ECM. The latter, together with tumoral and other cell secreted factors, constitute the "tumor matrisome". We share the challenges and opportunities for modeling this dynamic CAF/ECM unit, the tools and techniques available, and how the tumor matrisome is remodeled (e.g., via ECM proteases). We posit that increasing information on tumor matrisome dynamics may lead the field to alternative strategies for personalized medicine outside genomics.
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Affiliation(s)
- Shelly R. Peyton
- Department of Chemical Engineering, University of Massachusetts Amherst, Amherst, MA, USA
| | - Manu O. Platt
- Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Edna Cukierman
- Cancer Signaling & Microenvironment Program, Marvin and Concetta Greenberg Pancreatic Cancer Institute, Fox Chase Cancer Center, Temple Health, Philadelphia, PA, USA
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Creixell M, Kim H, Mohammadi F, Peyton SR, Meyer AS. Systems approaches to uncovering the contribution of environment-mediated drug resistance. CURRENT OPINION IN SOLID STATE & MATERIALS SCIENCE 2022; 26:101005. [PMID: 36321161 PMCID: PMC9620953 DOI: 10.1016/j.cossms.2022.101005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Cancer drug response is heavily influenced by the extracellular matrix (ECM) environment. Despite a clear appreciation that the ECM influences cancer drug response and progression, a unified view of how, where, and when environment-mediated drug resistance contributes to cancer progression has not coalesced. Here, we survey some specific ways in which the ECM contributes to cancer resistance with a focus on how materials development can coincide with systems biology approaches to better understand and perturb this contribution. We argue that part of the reason that environment-mediated resistance remains a perplexing problem is our lack of a wholistic view of the entire range of environments and their impacts on cell behavior. We cover a series of recent experimental and computational tools that will aid exploration of ECM reactions space, and how they might be synergistically integrated.
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Affiliation(s)
- Marc Creixell
- Department of Bioengineering, University of California Los Angeles
| | - Hyuna Kim
- Molecular and Cellular Biology Graduate Program, University of Massachusetts Amherst
| | - Farnaz Mohammadi
- Department of Bioengineering, University of California Los Angeles
| | - Shelly R Peyton
- Molecular and Cellular Biology Graduate Program, University of Massachusetts Amherst
- Department of Chemical Engineering, University of Massachusetts Amherst
| | - Aaron S Meyer
- Department of Bioengineering, University of California Los Angeles
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Intra-patient comparison of 3D and 2D magnetic resonance elastography techniques for assessment of liver stiffness. Abdom Radiol (NY) 2022; 47:998-1008. [PMID: 34982182 DOI: 10.1007/s00261-021-03355-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate performance of 3D magnetic resonance elastography (MRE) using spin-echo echo-planar imaging (seEPI) for assessment of hepatic stiffness compared with 2D gradient-recalled echo (GRE) and 2D seEPI sequences. METHODS Fifty-seven liver MRE examinations including 2D GRE, 2D seEPI, and 3D seEPI sequences were retrospectively evaluated. Elastograms were analyzed by 2 radiologists and polygonal regions of interests (ROIs) were drawn in 2 different fashions: "curated" ROI (avoiding liver edge, major vessels, and areas of wave interferences) and "non-curated" ROI (including largest cross section of liver, to assess the contribution of artifacts). Liver stiffness measurement (LSM) was calculated as the arithmetic mean of individual stiffness values for each technique. For 3D MRE, LSMs were also calculated based on 4 slices ("abbreviated LSM"). Intra-patient variations in LSMs and different methods of ROI placement were assessed by univariate tests. A p-value of < 0.05 was set as a statistically significant difference. RESULTS Mean surface areas of the ROIs were 50,723 mm2, 12,669 mm2, 5814 mm2, and 10,642 mm2 for 3D MRE, abbreviated 3D MRE, 2D GRE, and 2D seEPI, respectively. 3D LSMs based on curated and non-curated ROIs showed no clinically significant difference, with a mean difference less than 0.1 kPa. Abbreviated 3D LSMs had excellent correlation with 3D LSMs based on all slices (r = 0.9; p < 0.001) and were not significantly different (p = 0.927). CONCLUSION 3D MRE allows more reproducible measurements due to its lower susceptibility to artifacts and provides larger areas of parenchyma, enabling a more comprehensive evaluation of the liver.
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Liu S, Wu X, Yu Y, Wen X, Yu Z, Feng XQ, Zhao H. Geometric Confinement Guides the Expression of Cancer Stem Cell Molecular Markers CD44 via Cell Traction Forces. ACS Biomater Sci Eng 2020; 6:4623-4630. [PMID: 33455169 DOI: 10.1021/acsbiomaterials.0c00366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Cancer stem cells (CSCs) play a critical role in the cancer metastasis and account for tumor heterogeneity. Growing evidence indicates that the CSC phenotypes are related to the tumor microenvironment. In this study, we report that the gradient of mechanical stresses guides the spatial patterning of the expression of CD44 and Yes-associated protein (YAP) in the geometrically confined multicellular sheets. Our study shows that the cytoskeletal contraction regulates the expression of CD44 through the translocation of YAP into the nucleus. The results demonstrate that geometric confinement and mechanical stresses are the regulators in the spatial patterning of CSC. It may help to understand the relationship between the tumor microenvironment and oncogenesis.
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Affiliation(s)
- Sisi Liu
- Institute of Biomechanics and Medical Engineering, Department of Engineering Mechanics, Tsinghua University, Beijing 100084, P. R. China
| | - Xiaoan Wu
- Department of Physiology and Biophysics, Miller School of Medicine, University of Miami, Miami, Florida 33136, United States
| | - Yang Yu
- Institute of Biomechanics and Medical Engineering, Department of Engineering Mechanics, Tsinghua University, Beijing 100084, P. R. China
| | - Xiongwei Wen
- National Engineering Laboratory of Neuromodulation, Tsinghua University, Beijing 100084, P. R. China
| | - Zhang Yu
- Institute of Biomechanics and Medical Engineering, Department of Engineering Mechanics, Tsinghua University, Beijing 100084, P. R. China
| | - Xi-Qiao Feng
- Institute of Biomechanics and Medical Engineering, Department of Engineering Mechanics, Tsinghua University, Beijing 100084, P. R. China
| | - Hucheng Zhao
- Institute of Biomechanics and Medical Engineering, Department of Engineering Mechanics, Tsinghua University, Beijing 100084, P. R. China
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Li J, Venkatesh SK, Yin M. Advances in Magnetic Resonance Elastography of Liver. Magn Reson Imaging Clin N Am 2020; 28:331-340. [PMID: 32624152 DOI: 10.1016/j.mric.2020.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Magnetic resonance elastography (MRE) is the most accurate noninvasive technique in diagnosing fibrosis and cirrhosis in patients with chronic liver disease (CLD). The accuracy of hepatic MRE in distinguishing the severity of disease has been validated in studies of patients with various CLDs. Advanced hepatic MRE is a reliable, comfortable, and inexpensive alternative to liver biopsy for disease diagnosing, progression monitoring, and clinical decision making in patients with CLDs. This article summarizes current knowledge of the technical advances and innovations in hepatic MRE, and the clinical applications in various hepatic diseases.
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Affiliation(s)
- Jiahui Li
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | | | - Meng Yin
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Choi SL, Lee ES, Ko A, Park HJ, Park SB, Choi BI, Cho YY, Kannengiesser S. Technical success rates and reliability of spin-echo echo-planar imaging (SE-EPI) MR elastography in patients with chronic liver disease or liver cirrhosis. Eur Radiol 2020; 30:1730-1737. [PMID: 31728687 DOI: 10.1007/s00330-019-06496-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/01/2019] [Accepted: 10/02/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To determine the technical success rates of MR elastography (MRE) according to established gradient-recalled echo (GRE) and spin-echo echo-planar imaging (SE-EPI) sequences and to compare liver stiffness (LS) values between the sequences during expiratory and inspiratory phases in patients with chronic liver disease or liver cirrhosis. METHODS One hundred and eight patients who underwent MRE were included in this retrospective study. MRE was performed at 3 T based on both sequences during expiration as well as inspiration. Technical failure of MRE was determined if there was no pixel value with a confidence index higher than 95% and/or no apparent shear waves imaged. LS measurements were performed using free-drawing region of interest. To evaluate clinical factors related to the technical success rate of MRE, we assessed etiology of liver disease, ascites, body habitus, iron deposition, and liver morphology of patients. Statistical analysis was performed with the Wilcoxon test, Bland-Altman plot, independent t test, Mann-Whitney test, and McNemar test. RESULTS The technical success rate of MRE in SE-EPI was significantly higher than that of GRE (98.1% vs. 80.7%, p < 0.0001). On the basis of univariate analysis, height, weight, and BMI were significantly associated with failure of MRE (p < 0.05). There was no significant difference in LS values between GRE and SE-EPI (2.82 kPa vs. 2.92 kPa (p > 0.05)). However, the LS values were significantly higher during inspiration than expiration with both GRE and SE-EPI (p < 0.0001). CONCLUSION MRE in SE-EPI during expiratory breath-hold can be used as a reliable examination to evaluate liver fibrosis. KEY POINTS • The technical success rate of MR elastography in spin-echo echo-planar imaging (SE-EPI) was significantly higher than that in gradient-recalled echo (GRE) during both the inspiratory and expiratory phases. • Liver stiffness values were significantly higher during inspiration than during expiration in both GRE and SE-EPI. • MR elastography in SE-EPI during expiratory breath-hold can be used as a reliable examination in patients with liver fibrosis.
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Affiliation(s)
- Sang Lim Choi
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea.
| | - Ara Ko
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - Hyun Jeong Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - Sung Bin Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - Young Youn Cho
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
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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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11
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Emerging Concepts and Tools in Cell Mechanomemory. Ann Biomed Eng 2019; 48:2103-2112. [DOI: 10.1007/s10439-019-02412-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 11/11/2019] [Indexed: 12/25/2022]
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Zhu P, Tseng NH, Xie T, Li N, Fitts-Sprague I, Peyton SR, Sun Y. Biomechanical Microenvironment Regulates Fusogenicity of Breast Cancer Cells. ACS Biomater Sci Eng 2019; 5:3817-3827. [PMID: 33438422 PMCID: PMC9800072 DOI: 10.1021/acsbiomaterials.8b00861] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Fusion of cancer cells is thought to contribute to tumor development and drug resistance. The low frequency of cell fusion events and the instability of fused cells have hindered our ability to understand the molecular mechanisms that govern cell fusion. We have demonstrated that several breast cancer cell lines can fuse into multinucleated giant cells in vitro, and the initiation and longevity of fused cells can be regulated solely by biophysical factors. Dynamically tuning the adhesive area of the patterned substrates, reducing cytoskeletal tensions pharmacologically, altering matrix stiffness, and modulating pattern curvature all supported the spontaneous fusion and stability of these multinucleated giant cells. These observations highlight that the biomechanical microenvironment of cancer cells, including the matrix rigidity and interfacial curvature, can directly modulate their fusogenicity, an unexplored mechanism through which biophysical cues regulate tumor progression.
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Affiliation(s)
- Peiran Zhu
- Department of Mechanical and Industrial Engineering, University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - Ning-Hsuan Tseng
- Molecular and Cellular Biology Graduate Program, University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - Tianfa Xie
- Department of Mechanical and Industrial Engineering, University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - Ningwei Li
- Department of Mechanical and Industrial Engineering, University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - Isaac Fitts-Sprague
- Department of Mechanical and Industrial Engineering, University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - Shelly R. Peyton
- Molecular and Cellular Biology Graduate Program, University of Massachusetts, Amherst, Massachusetts 01003, USA.,Department of Chemical Engineering, University of Massachusetts, Amherst, Massachusetts 01003, USA.,Institue for Applied Life Sciences, University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - Yubing Sun
- Department of Mechanical and Industrial Engineering, University of Massachusetts, Amherst, Massachusetts 01003, USA.,Molecular and Cellular Biology Graduate Program, University of Massachusetts, Amherst, Massachusetts 01003, USA.,Department of Chemical Engineering, University of Massachusetts, Amherst, Massachusetts 01003, USA.,Institue for Applied Life Sciences, University of Massachusetts, Amherst, Massachusetts 01003, USA.,Corresponding Author: Correspondence should be addressed to Y. Sun ()
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Guenthner C, Sethi S, Troelstra M, Dokumaci AS, Sinkus R, Kozerke S. Ristretto MRE: A generalized multi-shot GRE-MRE sequence. NMR IN BIOMEDICINE 2019; 32:e4049. [PMID: 30697827 PMCID: PMC6590281 DOI: 10.1002/nbm.4049] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 10/16/2018] [Accepted: 11/09/2018] [Indexed: 05/12/2023]
Abstract
In order to acquire consistent k-space data in MR elastography, a fixed temporal relationship between the MRI sequence and the underlying period of the wave needs to be ensured. To this end, conventional GRE-MRE enforces synchronization through repeated triggering of the transducer and forcing the sequence repetition time to be equal to an integer multiple of the wave period. For wave frequencies below 100 Hz, however, this leads to prolonged acquisition times, as the repetition time scales inversely with frequency. A previously developed multi-shot approach (eXpresso MRE) to multi-slice GRE-MRE tackles this issue by acquiring an integer number of slices per wave period, which allows acquisition to be accelerated in typical scenarios by a factor of two or three. In this work, it is demonstrated that the constraints imposed by the eXpresso scheme are overly restrictive. We propose a generalization of the sequence in three steps by incorporating sequence delays into imaging shots and allowing for interleaved wave-phase acquisition. The Ristretto scheme is compared in terms of imaging shot and total scan duration relative to eXpresso and conventional GRE-MRE and is validated in three different phantom studies. First, the agreement of measured displacement fields in different stages of the sequence generalization is shown. Second, performance is compared for 25, 36, 40, and 60 Hz actuation frequencies. Third, the performance is assessed for the acquisition of different numbers of slices (13 to 17). In vivo feasibility is demonstrated in the liver and the breast. Here, Ristretto is compared with an optimized eXpresso sequence, leading to scan accelerations of 15% and 5%, respectively, without compromising displacement field and stiffness estimates in general. The Ristretto concept allows us to choose imaging shot durations on a fine grid independent of the number of slices and the wave frequency, permitting 2- to 4.5-fold acceleration of conventional GRE-MRE acquisitions.
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Affiliation(s)
- Christian Guenthner
- Institute for Biomedical EngineeringUniversity and ETH ZurichZurichSwitzerland
| | - Sweta Sethi
- Division of Research OncologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Marian Troelstra
- Division of Imaging Sciences & Biomedical EngineeringKing's College LondonLondonUK
- Department of Radiology and Nuclear MedicineAcademic Medical CenterAmsterdamThe Netherlands
| | - Ayse Sila Dokumaci
- Division of Imaging Sciences & Biomedical EngineeringKing's College LondonLondonUK
| | - Ralph Sinkus
- Division of Imaging Sciences & Biomedical EngineeringKing's College LondonLondonUK
| | - Sebastian Kozerke
- Institute for Biomedical EngineeringUniversity and ETH ZurichZurichSwitzerland
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14
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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: 29] [Impact Index Per Article: 4.8] [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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15
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Sinkus R, Lambert S, Abd-Elmoniem KZ, Morse C, Heller T, Guenthner C, Ghanem AM, Holm S, Gharib AM. Rheological determinants for simultaneous staging of hepatic fibrosis and inflammation in patients with chronic liver disease. NMR IN BIOMEDICINE 2018; 31:e3956. [PMID: 30059174 PMCID: PMC6141320 DOI: 10.1002/nbm.3956] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 05/05/2018] [Accepted: 05/07/2018] [Indexed: 05/12/2023]
Abstract
The purpose of this study is to investigate the use of fundamental rheological parameters as quantified by MR elastography (MRE) to measure liver fibrosis and inflammation simultaneously in humans. MRE was performed on 45 patients at 3 T using a vibration frequency of 56 Hz. Fibrosis and inflammation scores were obtained from liver biopsies. Biomechanical properties were quantified in terms of complex shear modulus G* as well as shear wave phase velocity c and shear wave attenuation α. A rheological fractional derivative order model was used to investigate the linear dependence of the free model parameters (dispersion slope y, intrinsic speed c0 , and intrinsic relaxation time τ) on histopathology. Leave-one-out cross-validation was then utilized to demonstrate the effectiveness of the model. The intrinsic speed c0 increases with hepatic fibrosis, while an increased relaxation time τ is reflective of more inflammation of the liver parenchyma. The dispersion slope y does not depend either on fibrosis or on inflammation. The proposed rheological model, given this specific parameterization, establishes the functional dependences of biomechanical parameters on histological fibrosis and inflammation. The leave-one-out cross-validation demonstrates that the model allows identification, from the MRE measurements, of the histology scores when grouped into low-/high-grade fibrosis and low-/high-grade inflammation with significance levels of P = 0.0004 (fibrosis) and P = 0.035 (inflammation). The functional dependences of intrinsic speed and relaxation time on fibrosis and inflammation, respectively, shed new light onto the impact hepatic pathological changes on liver tissue biomechanics in humans. The dispersion slope y appears to represent a structural parameter of liver parenchyma not impacted by the severity of fibrosis/inflammation present in this patient cohort. This specific parametrization of the well-established rheological fractional order model is valuable for the clinical assessment of both fibrosis and inflammation scores, going beyond the capability of the plain shear modulus measurement commonly used for MRE.
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Affiliation(s)
- Ralph Sinkus
- Inserm U1148, LVTS, University Paris Diderot, University Paris 13, Paris, France
- King's College London, BHF Centre of Excellence, Division of Imaging Sciences and Biomedical Engineering, UK
| | - Simon Lambert
- King's College London, BHF Centre of Excellence, Division of Imaging Sciences and Biomedical Engineering, UK
| | - Khaled Z Abd-Elmoniem
- Biomedical and Metabolic Imaging Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Caryn Morse
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD, USA
| | - Theo Heller
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Christian Guenthner
- Institute for Biomedical Engineering, University and ETH, Zurich, Zurich, Switzerland
| | - Ahmed M Ghanem
- Biomedical and Metabolic Imaging Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Sverre Holm
- Department of Informatics, University of Oslo, Norway
| | - Ahmed M Gharib
- Biomedical and Metabolic Imaging Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
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16
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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: 26] [Impact Index Per Article: 3.7] [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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17
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Guenthner C, Kozerke S. Encoding and readout strategies in magnetic resonance elastography. NMR IN BIOMEDICINE 2018; 31:e3919. [PMID: 29806865 DOI: 10.1002/nbm.3919] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 12/15/2017] [Accepted: 02/15/2018] [Indexed: 06/08/2023]
Abstract
Magnetic resonance elastography (MRE) has evolved significantly since its inception. Advances in motion-encoding gradient design and readout strategies have led to improved encoding and signal-to-noise ratio (SNR) efficiencies, which in turn allow for higher spatial resolution, increased coverage, and/or shorter scan times. The purpose of this review is to summarize MRE wave-encoding and readout approaches in a unified mathematical framework to allow for a comparative assessment of encoding and SNR efficiency of the various methods available. Besides standard full- and fractional-wave-encoding approaches, advanced techniques including flow compensation, sample interval modulation and multi-shot encoding are considered. Signal readout using fast k-space trajectories, reduced field of view, multi-slice, and undersampling techniques are summarized and put into perspective. The review is concluded with a foray into displacement and diffusion encoding as alternative and/or complementary techniques.
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Affiliation(s)
- Christian Guenthner
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
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18
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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: 10] [Impact Index Per Article: 1.4] [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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19
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Cunha GM, Glaser KJ, Bergman A, Luz RP, de Figueiredo EH, Lobo Lopes FPP. Feasibility and agreement of stiffness measurements using gradient-echo and spin-echo MR elastography sequences in unselected patients undergoing liver MRI. Br J Radiol 2018; 91:20180126. [PMID: 29718694 DOI: 10.1259/bjr.20180126] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To evaluate the agreement of three MR elastography (MRE) sequences in patients undergoing liver MRI for clinical care. Methods: A cross-sectional retrospective study was performed with 223 patients referred for liver MRI, including 12 patients with liver iron overload. Data obtained with spin-echo (SE) and gradient-echo (GRE) MRE sequences were compared. Multiple linear regression adjusted for the presence of liver fat was also performed to assess the correlation between fat infiltration and stiffness measurements results. Agreement between two SE sequences was assessed in patients with liver iron overload. Results: We found strong correlation between the GRE sequence and two SE sequences. Spearman's correlation coefficients between the GRE, SE, and SE-EPI MRE sequences in patients with liver R2* <75Hz were 0.74, 0.81, and 0.80. GRE-MRE failed in patients with liver R2* > 75 Hz. In this subgroup, the correlation coefficient between both SE-MRE sequences was 0.97. Liver fat did not interfere with the results. CONCLUSION In clinical setting, there is a high correlation between the GRE and SE MRE stiffness measurements, independently of the degree of liver fat infiltration measured by PDFF. A strong correlation between SE-MRE sequences is found even in patients with iron overload. Advances in knowledge: Our study addresses liver iron and fat content simultaneously to describing the technical feasibility and correlation between different MRE sequences in consecutive unselected patients refereed for liver MRI. EPI SE-MRE should be considered an optimal alternative to assess liver fibrosis in patients in whom GRE-MRE failures, such as iron-overloaded, in pediatric, elderly, or severely ill populations.
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Affiliation(s)
- Guilherme Moura Cunha
- 1 MRI Department, Clínica de Diagnóstico por Imagem CDPI-DASA , Rio de Janeiro , Brazil
| | - Kevin J Glaser
- 2 Department of Radiology, Mayo Clinic , Rochester, MN , USA
| | - Anke Bergman
- 3 Programa de Carcinogênese Molecular, Instituto Nacional de Câncer (INCA) , Rio de Janeiro , Brazil
| | - Rodrigo P Luz
- 4 Hepatology, Universidade Federal do Rio De Janeiro, UFRJ, Cidade Universitária , Rio de Janeiro , Brazil
| | | | - Flavia Paiva Proença Lobo Lopes
- 1 MRI Department, Clínica de Diagnóstico por Imagem CDPI-DASA , Rio de Janeiro , Brazil.,6 Radiology Department, School of Medicine, Universidade Federal do Rio de Janeiro UFRJ , Rio de Janeiro , Brazil
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20
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Magnetic Resonance Elastography of the Liver: Qualitative and Quantitative Comparison of Gradient Echo and Spin Echo Echoplanar Imaging Sequences. Invest Radiol 2017; 51:575-81. [PMID: 26982699 DOI: 10.1097/rli.0000000000000269] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of this study was to compare 2-dimensional (2D) gradient recalled echo (GRE) and 2D spin echo echoplanar imaging (SE-EPI) magnetic resonance elastography (MRE) sequences of the liver in terms of image quality and quantitative liver stiffness (LS) measurement. MATERIALS AND METHODS This prospective study involved 50 consecutive subjects (male/female, 33/17; mean age, 58 years) who underwent liver magnetic resonance imaging at 3.0 T including 2 MRE sequences, 2D GRE, and 2D SE-EPI (acquisition time 56 vs 16 seconds, respectively). Image quality scores were assessed by 2 independent observers based on wave propagation and organ coverage on the confidence map (range, 0-15). A third observer measured LS on stiffness maps (in kilopascal). Mean LS values, regions of interest size (based on confidence map), and image quality scores between SE-EPI and GRE-MRE were compared using paired nonparametric Wilcoxon test. Reproducibility of LS values between the 2 sequences was assessed using intraclass coefficient correlation, coefficient of variation, and Bland-Altman limits of agreement. T2* effect on image quality was assessed using partial Spearman correlation. RESULTS There were 4 cases of failure with GRE-MRE and none with SE-EPI-MRE. Image quality scores and region of interest size were significantly higher using SE-EPI-MRE versus GRE-MRE (P < 0.0001 for both measurements and observers). Liver stiffness measurements were not significantly different between the 2 sequences (3.75 ± 1.87 kPa vs 3.55 ± 1.51 kPa, P = 0.062), were significantly correlated (intraclass coefficient correlation, 0.909), and had excellent reproducibility (coefficient of variation, 10.2%; bias, 0.023; Bland-Altman limits of agreement, -1.19; 1.66 kPa). Image quality scores using GRE-MRE were significantly correlated with T2* while there was no correlation for SE-EPI-MRE. CONCLUSIONS Our data suggest that SE-EPI-MRE may be a better alternative to GRE-MRE. The diagnostic performance of SE-EPI-MRE for detection of liver fibrosis needs to be assessed in a future study.
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21
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Yue JL, Tardieu M, Julea F, Boucneau T, Sinkus R, Pellot-Barakat C, Maître X. Acquisition and reconstruction conditions in silico for accurate and precise magnetic resonance elastography. ACTA ACUST UNITED AC 2017; 62:8655-8670. [DOI: 10.1088/1361-6560/aa9164] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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22
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Joshi M, Dillman JR, Towbin AJ, Serai SD, Trout AT. MR elastography: high rate of technical success in pediatric and young adult patients. Pediatr Radiol 2017; 47:838-843. [PMID: 28367603 DOI: 10.1007/s00247-017-3831-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/25/2017] [Accepted: 03/06/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Magnetic resonance (MR) elastography allows the noninvasive assessment of liver stiffness, which is a surrogate for fibrosis. OBJECTIVE The purpose of this study was to describe our experience using liver MR elastography in a large pediatric population with attention to the frequency and causes of exam failure. MATERIALS AND METHODS Imaging records were searched for patients ≤18 years of age who underwent 2-D gradient recalled echo (GRE) MR elastography of the liver between September 2011 and August 2015 on one of two 1.5-T MRI platforms. Imaging reports and clinical records were reviewed for failed MR elastography acquisitions, factor(s) resulting in failure and whether a subsequent successful examination had been performed. RESULTS Four hundred sixty-eight MR elastography examinations were performed in 372 patients between 1.5 months and 18 years of age during the study period. Ninety-six percent (450/468) of the examinations were successful. There was no significant difference in mean age (12.6±3.6 vs. 11.2±4.1 years, P=0.12) or body mass index (BMI) (28.2±12.4 vs. 29.5±10 kg/m2, P=0.6) between patients with and without successful examinations. MR elastography failures were due to poor paddle positioning resulting in inadequate generation of hepatic shear waves (n=5), iron overload (n=4), patient inability to tolerate MRI (n=3), patient breathing/motion (n=3), artifact from implanted hardware (n=1) and technical malfunction (n=2). Seven of nine (78%) repeat examinations were successful (78%). CONCLUSION Hepatic 2-D GRE MR elastography at 1.5 T is technically robust in children. Exam failure is infrequent and largely reflects patient specific factors, some of which can be mitigated with careful technique.
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Affiliation(s)
- Madalsa Joshi
- Department of Radiology, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Jonathan R Dillman
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229-3026, USA
| | - Alexander J Towbin
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229-3026, USA
| | - Suraj D Serai
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229-3026, USA
| | - Andrew T Trout
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229-3026, USA.
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23
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Kim YS, Song JS, Kannengiesser S, Seo SY. Comparison of spin-echo echoplanar imaging and gradient recalled echo-based MR elastography at 3 Tesla with and without gadoxetic acid administration. Eur Radiol 2017; 27:4120-4128. [PMID: 28289936 DOI: 10.1007/s00330-017-4781-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/11/2016] [Accepted: 02/16/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To compare spin-echo echoplanar imaging (SE-EPI) and gradient recalled echo (GRE) MR elastography (MRE) at 3 T with and without gadoxetic acid administration. METHODS We included 84 patients who underwent MRE before and after gadoxetic acid administration, each time using SE-EPI and GRE sequences. Diagnostic performance for predicting clinical liver cirrhosis and high-risk oesophageal varices was assessed using the area under the receiver-operating characteristic curve (AUC). The relationships between T2* and success of MRE, and correlations of liver stiffness (LS) values between the two sequences or before and after gadoxetic acid administration, were investigated. RESULTS SE-EPI-MRE resulted in a significantly lower failure rate than GRE-MRE (1.19% vs. 10.71%, P = 0.018). Increased T2* was related to higher probability of successful LS measurement (odds ratio, 1.426; P = 0.004). The AUC of SE-EPI-MRE was comparable to that of GRE-MRE for the detection of clinical liver cirrhosis (0.938 vs. 0.948, P = 0.235) and high-risk oesophageal varices (0.839 vs. 0.752, P = 0.354). LS values were not significantly different before and after gadoxetic acid administration. CONCLUSION SE-EPI-MRE can substitute for GRE-MRE for the detection of clinical liver cirrhosis and high-risk oesophageal varices. SE-EPI-MRE is particularly useful in patients with iron deposition, with lower failure rates than GRE-MRE. KEY POINTS • LS values are comparable between SE-EPI-MRE and GRE-MRE. • Administration of gadoxetic acid does not influence LS measurement. • The failure rate of SE-EPI-MRE is significantly lower than that of GRE-MRE.
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Affiliation(s)
- Yong Seek Kim
- Department of Radiology, Chonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, Chonbuk, 54907, Korea
| | - Ji Soo Song
- Department of Radiology, Chonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, Chonbuk, 54907, Korea. .,Research Institute of Clinical Medicine of Chonbuk National University, 20 Geonji-ro, Deokjin-gu, Jeonju, Chonbuk, 54907, Korea. .,Biomedical Research Institute of Chonbuk National University Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, Chonbuk, 54907, Korea.
| | | | - Seung Young Seo
- Research Institute of Clinical Medicine of Chonbuk National University, 20 Geonji-ro, Deokjin-gu, Jeonju, Chonbuk, 54907, Korea.,Biomedical Research Institute of Chonbuk National University Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, Chonbuk, 54907, Korea.,Department of Internal Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
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24
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Wagner M, Corcuera-Solano I, Lo G, Esses S, Liao J, Besa C, Chen N, Abraham G, Fung M, Babb JS, Ehman RL, Taouli B. Technical Failure of MR Elastography Examinations of the Liver: Experience from a Large Single-Center Study. Radiology 2017; 284:401-412. [PMID: 28045604 DOI: 10.1148/radiol.2016160863] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose To assess the determinants of technical failure of magnetic resonance (MR) elastography of the liver in a large single-center study. Materials and Methods This retrospective study was approved by the institutional review board. Seven hundred eighty-one MR elastography examinations performed in 691 consecutive patients (mean age, 58 years; male patients, 434 [62.8%]) in a single center between June 2013 and August 2014 were retrospectively evaluated. MR elastography was performed at 3.0 T (n = 443) or 1.5 T (n = 338) by using a gradient-recalled-echo pulse sequence. MR elastography and anatomic image analysis were performed by two observers. Additional observers measured liver T2* and fat fraction. Technical failure was defined as no pixel value with a confidence index higher than 95% and/or no apparent shear waves imaged. Logistic regression analysis was performed to assess potential predictive factors of technical failure of MR elastography. Results The technical failure rate of MR elastography at 1.5 T was 3.5% (12 of 338), while it was higher, 15.3% (68 of 443), at 3.0 T. On the basis of univariate analysis, body mass index, liver iron deposition, massive ascites, use of 3.0 T, presence of cirrhosis, and alcoholic liver disease were all significantly associated with failure of MR elastography (P < .004); but on the basis of multivariable analysis, only body mass index, liver iron deposition, massive ascites, and use of 3.0 T were significantly associated with failure of MR elastography (P < .004). Conclusion The technical failure rate of MR elastography with a gradient-recalled-echo pulse sequence was low at 1.5 T but substantially higher at 3.0 T. Massive ascites, iron deposition, and high body mass index were additional independent factors associated with failure of MR elastography of the liver with a two-dimensional gradient-recalled-echo pulse sequence. © RSNA, 2017.
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Affiliation(s)
- Mathilde Wagner
- From the Translational and Molecular Imaging Institute (M.W., I.C.S., C.B., N.C., B.T.) and Department of Radiology (I.C.S., G.L., S.E., J.L., C.B., G.A., B.T.), Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029; MR Applications and Workflow, GE Healthcare, New York, NY (M.F.); Department of Radiology, New York University Langone Medical Center, New York, NY (J.S.B.); and Department of Radiology, Mayo Clinic, Rochester, Minn (R.L.E.)
| | - Idoia Corcuera-Solano
- From the Translational and Molecular Imaging Institute (M.W., I.C.S., C.B., N.C., B.T.) and Department of Radiology (I.C.S., G.L., S.E., J.L., C.B., G.A., B.T.), Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029; MR Applications and Workflow, GE Healthcare, New York, NY (M.F.); Department of Radiology, New York University Langone Medical Center, New York, NY (J.S.B.); and Department of Radiology, Mayo Clinic, Rochester, Minn (R.L.E.)
| | - Grace Lo
- From the Translational and Molecular Imaging Institute (M.W., I.C.S., C.B., N.C., B.T.) and Department of Radiology (I.C.S., G.L., S.E., J.L., C.B., G.A., B.T.), Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029; MR Applications and Workflow, GE Healthcare, New York, NY (M.F.); Department of Radiology, New York University Langone Medical Center, New York, NY (J.S.B.); and Department of Radiology, Mayo Clinic, Rochester, Minn (R.L.E.)
| | - Steven Esses
- From the Translational and Molecular Imaging Institute (M.W., I.C.S., C.B., N.C., B.T.) and Department of Radiology (I.C.S., G.L., S.E., J.L., C.B., G.A., B.T.), Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029; MR Applications and Workflow, GE Healthcare, New York, NY (M.F.); Department of Radiology, New York University Langone Medical Center, New York, NY (J.S.B.); and Department of Radiology, Mayo Clinic, Rochester, Minn (R.L.E.)
| | - Joseph Liao
- From the Translational and Molecular Imaging Institute (M.W., I.C.S., C.B., N.C., B.T.) and Department of Radiology (I.C.S., G.L., S.E., J.L., C.B., G.A., B.T.), Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029; MR Applications and Workflow, GE Healthcare, New York, NY (M.F.); Department of Radiology, New York University Langone Medical Center, New York, NY (J.S.B.); and Department of Radiology, Mayo Clinic, Rochester, Minn (R.L.E.)
| | - Cecilia Besa
- From the Translational and Molecular Imaging Institute (M.W., I.C.S., C.B., N.C., B.T.) and Department of Radiology (I.C.S., G.L., S.E., J.L., C.B., G.A., B.T.), Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029; MR Applications and Workflow, GE Healthcare, New York, NY (M.F.); Department of Radiology, New York University Langone Medical Center, New York, NY (J.S.B.); and Department of Radiology, Mayo Clinic, Rochester, Minn (R.L.E.)
| | - Nelson Chen
- From the Translational and Molecular Imaging Institute (M.W., I.C.S., C.B., N.C., B.T.) and Department of Radiology (I.C.S., G.L., S.E., J.L., C.B., G.A., B.T.), Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029; MR Applications and Workflow, GE Healthcare, New York, NY (M.F.); Department of Radiology, New York University Langone Medical Center, New York, NY (J.S.B.); and Department of Radiology, Mayo Clinic, Rochester, Minn (R.L.E.)
| | - Ginu Abraham
- From the Translational and Molecular Imaging Institute (M.W., I.C.S., C.B., N.C., B.T.) and Department of Radiology (I.C.S., G.L., S.E., J.L., C.B., G.A., B.T.), Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029; MR Applications and Workflow, GE Healthcare, New York, NY (M.F.); Department of Radiology, New York University Langone Medical Center, New York, NY (J.S.B.); and Department of Radiology, Mayo Clinic, Rochester, Minn (R.L.E.)
| | - Maggie Fung
- From the Translational and Molecular Imaging Institute (M.W., I.C.S., C.B., N.C., B.T.) and Department of Radiology (I.C.S., G.L., S.E., J.L., C.B., G.A., B.T.), Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029; MR Applications and Workflow, GE Healthcare, New York, NY (M.F.); Department of Radiology, New York University Langone Medical Center, New York, NY (J.S.B.); and Department of Radiology, Mayo Clinic, Rochester, Minn (R.L.E.)
| | - James S Babb
- From the Translational and Molecular Imaging Institute (M.W., I.C.S., C.B., N.C., B.T.) and Department of Radiology (I.C.S., G.L., S.E., J.L., C.B., G.A., B.T.), Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029; MR Applications and Workflow, GE Healthcare, New York, NY (M.F.); Department of Radiology, New York University Langone Medical Center, New York, NY (J.S.B.); and Department of Radiology, Mayo Clinic, Rochester, Minn (R.L.E.)
| | - Richard L Ehman
- From the Translational and Molecular Imaging Institute (M.W., I.C.S., C.B., N.C., B.T.) and Department of Radiology (I.C.S., G.L., S.E., J.L., C.B., G.A., B.T.), Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029; MR Applications and Workflow, GE Healthcare, New York, NY (M.F.); Department of Radiology, New York University Langone Medical Center, New York, NY (J.S.B.); and Department of Radiology, Mayo Clinic, Rochester, Minn (R.L.E.)
| | - Bachir Taouli
- From the Translational and Molecular Imaging Institute (M.W., I.C.S., C.B., N.C., B.T.) and Department of Radiology (I.C.S., G.L., S.E., J.L., C.B., G.A., B.T.), Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029; MR Applications and Workflow, GE Healthcare, New York, NY (M.F.); Department of Radiology, New York University Langone Medical Center, New York, NY (J.S.B.); and Department of Radiology, Mayo Clinic, Rochester, Minn (R.L.E.)
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Choi SH, Jeong WK, Kim Y, Lim S, Kwon JW, Kim TY, Kim MY, Sohn JH. How many times should we repeat measuring liver stiffness using shear wave elastography?: 5-repetition versus 10-repetition protocols. ULTRASONICS 2016; 72:158-164. [PMID: 27529140 DOI: 10.1016/j.ultras.2016.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/19/2016] [Accepted: 08/05/2016] [Indexed: 06/06/2023]
Abstract
The purpose of this study is to evaluate whether a 5-repetition liver stiffness (LS) measurement as the standard protocol of shear wave elastography (SWE) is comparable to a conventional 10-repetition measurement protocol and to identify factors that influence the reliability of the 5-repetition protocol. A total of 346 patients (mean, 48.0years; range, 15-81years, M:F=192:154) who underwent SWE were enrolled. The median, first quartile, third quartile, and interquartile range divided by the median (IQR/M) of LS measurement were calculated and compared between 5-repetition and 10-repetition protocols. Subgroup analyses were also performed to identify factors associated with measurement reliability. The overall mean LS from the 10-repetition protocol was 7.97kPa, which was not significantly different from the mean LS of the 5-repetition protocol (7.91kPa; p=0.192). However, the third quartile and IQR/M values of the two groups were significantly different from each other (p=0.003 and <0.001). Subgroup analysis revealed that the 5-repetition results were significantly different from the 10-repetition results in the fatty liver and high LS subgroups. Therefore, the 5-repetition SWE measurement protocol can replace the conventional 10-repetition protocol, with the exception of patients with fatty liver disease or an LS value higher than 10kPa.
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Affiliation(s)
- Seung Hee Choi
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea.
| | - Yongsoo Kim
- Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, 153 Gyeongchun-ro, Guri-si, Gyeonggi-do 11923, Republic of Korea
| | - Sanghyeok Lim
- Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, 153 Gyeongchun-ro, Guri-si, Gyeonggi-do 11923, Republic of Korea
| | - Jong Won Kwon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Tae Yeob Kim
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, 153 Gyeongchun-ro, Guri-si, Gyeonggi-do 11923, Republic of Korea
| | - Min Yeong Kim
- Department of Radiology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7 Keunjaebong-gil, Hwaseong-si, Gyeonggi-do 18450, Republic of Korea
| | - Joo Hyun Sohn
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, 153 Gyeongchun-ro, Guri-si, Gyeonggi-do 11923, Republic of Korea
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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: 38] [Impact Index Per Article: 4.2] [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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Editorial: A New Spin on Magnetic Resonance Elastography. Am J Gastroenterol 2016; 111:834-7. [PMID: 27249983 DOI: 10.1038/ajg.2016.134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 03/07/2016] [Indexed: 12/11/2022]
Abstract
The development of hepatic fibrosis is the hallmark of liver disease progression. Identifying fibrosis across the spectrum, from early stages to cirrhosis has become a major unmet need. Newer imaging techniques that measure liver elastography (stiffness) as a surrogate of fibrosis seem to outperform serum tests. The current study compares two-dimensional (2D) gradient-recalled echo magnetic resonance elastography (MRE) to three-dimensional (3D) spin-echo echo-planar imaging MRE. 3D-SE-EPI MRE was able to image more liver volume in less time with fewer technical failures. The current study demonstrates that 3D-SE-EPI MRE appears marginally superior to 2D-GRE and may evolve into the new gold standard.
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Yang Q, Yu T, Yun S, Zhang H, Chen X, Cheng Z, Zhong J, Huang J, Okuaki T, Chan Q, Liang B, Guo H. Comparison of multislice breath-hold and 3D respiratory triggeredT1ρ imaging of liver in healthy volunteers and liver cirrhosis patients in 3.0 T MRI. J Magn Reson Imaging 2016; 44:906-13. [PMID: 27149283 DOI: 10.1002/jmri.25253] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 03/06/2016] [Indexed: 01/09/2023] Open
Affiliation(s)
- Qihua Yang
- Sun Yat-Sen Memorial Hospital; Guang Zhou Guang Dong China
| | - Taihui Yu
- Sun Yat-Sen Memorial Hospital; Guang Zhou Guang Dong China
| | - Su Yun
- Sun Yat-Sen Memorial Hospital; Guang Zhou Guang Dong China
| | - Hui Zhang
- Center for Biomedical Imaging Research; Department of Biomedical Engineering; Tsinghua University; Beijing China
| | - Xiaodong Chen
- Sun Yat-Sen Memorial Hospital; Guang Zhou Guang Dong China
| | - Ziliang Cheng
- Sun Yat-Sen Memorial Hospital; Guang Zhou Guang Dong China
| | - Jinglian Zhong
- Sun Yat-Sen Memorial Hospital; Guang Zhou Guang Dong China
| | - Jingwen Huang
- Sun Yat-Sen Memorial Hospital; Guang Zhou Guang Dong China
| | | | | | - Biling Liang
- Sun Yat-Sen Memorial Hospital; Guang Zhou Guang Dong China
| | - Hua Guo
- Center for Biomedical Imaging Research; Department of Biomedical Engineering; Tsinghua University; Beijing China
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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: 71] [Impact Index Per Article: 7.9] [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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Low G, Owen NE, Joubert I, Patterson AJ, Graves MJ, Glaser KJ, Alexander GJM, Lomas DJ. Reliability of magnetic resonance elastography using multislice two-dimensional spin-echo echo-planar imaging (SE-EPI) and three-dimensional inversion reconstruction for assessing renal stiffness. J Magn Reson Imaging 2015; 42:844-50. [PMID: 25537823 PMCID: PMC4560097 DOI: 10.1002/jmri.24826] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 12/01/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To evaluate the reliability of MRE using a spin-echo echo-planar imaging (SE-EPI) renal MRE technique in healthy volunteers. METHODS Institutional review board approved prospective study in which all participants provided written informed consent. Sixteen healthy volunteers comprising seven males and nine females with a median age of 35 years (age range: 23 to 59 years) were included. Coronal 90 Hz and 60 Hz MRE acquisitions were performed twice within a 30-min interval between examinations. Renal MRE reliability was assessed by (i) test-retest repeatability, and (ii) inter-rater agreement between two independent readers. The MRE-measured averaged renal stiffness values were evaluated using: intraclass correlation coefficient (ICC), Bland-Altman and the within-subject coefficient of variation (COV). RESULTS For test-retest repeatability, Bland-Altman showed a mean stiffness difference between examinations of 0.07 kPa (95% limits of agreement: -1.41, 1.54) at 90 Hz and 0.01 kPa (95% limits of agreement: -0.51, 0.53) at 60 Hz. Coefficient of repeatability was 1.47 kPa and 0.52 kPa at 90 Hz and 60 Hz, respectively. The within-subject COV was 13.6% and 7.7% at 90 Hz and 60 Hz, respectively. ICC values were 0.922 and 0.907 for test-retest repeatability and 0.998 and 0.989 for inter-rater agreement, respectively (P < 0.001). CONCLUSION SE-EPI renal MRE is a reliable technique.
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Affiliation(s)
- Gavin Low
- Department of Radiology, Addenbrooke's Hospital, University of Cambridge, England, United Kingdom
- University of Alberta, Edmonton, Alberta, Canada
| | - Nicola E Owen
- Division of Gastroenterology & Hepatology, Cambridge University Hospitals NHS Foundation Trust Hospital, England, United Kingdom
| | - Ilse Joubert
- Department of Radiology, Addenbrooke's Hospital, University of Cambridge, England, United Kingdom
| | - Andrew J Patterson
- Department of Radiology, Addenbrooke's Hospital, University of Cambridge, England, United Kingdom
| | - Martin J Graves
- Department of Radiology, Addenbrooke's Hospital, University of Cambridge, England, United Kingdom
| | - Kevin J Glaser
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Graeme J M Alexander
- Division of Gastroenterology & Hepatology, Cambridge University Hospitals NHS Foundation Trust Hospital, England, United Kingdom
| | - David J Lomas
- Department of Radiology, Addenbrooke's Hospital, University of Cambridge, England, United Kingdom
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Yin M, Glaser KJ, Talwalkar JA, Chen J, Manduca A, Ehman RL. Hepatic MR Elastography: Clinical Performance in a Series of 1377 Consecutive Examinations. Radiology 2015; 278:114-24. [PMID: 26162026 DOI: 10.1148/radiol.2015142141] [Citation(s) in RCA: 221] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To assess the technical success rate and diagnostic performance of liver magnetic resonance (MR) elastography. MATERIALS AND METHODS This retrospective study was approved by the institutional review board with patient informed consent. A total of 1377 consecutive MR elastography examinations performed between 2007 and 2010 in 1287 patients for clinical indications were included. Medical records were used to retrieve liver stiffness as assessed with MR elastography, histologic analysis, blood work, and other liver disease-related information. Nonparametric Kruskal-Wallis tests and analysis of covariance methods were used to evaluate the diagnostic values and relationships of the collected data. RESULTS Hepatic MR elastography had a success rate of 94.4% (1300 of 1377 cases) and yielded reproducible measurements (r = 0.9716, P < .0001) in the study cohort, with a complex patient profile and multiple interpreters. Body mass index had no significant effect on success rate (P = .2). In 289 patients who underwent liver biopsy within 1 year of the MR elastography date, mean liver stiffness as assessed with MR elastography was significantly higher in patients with advanced fibrosis (stages F3, F4) than in those with mild to moderate fibrosis (stages F0, F1, F2) (5.93 kPa ± 2.31 [standard deviation] vs 3.35 kPa ± 1.44, P < .0001). Liver stiffness is associated with many factors other than fibrosis extent, including cause of fibrosis (viral hepatitis C vs nonalcoholic fatty liver disease, P = .025), inflammation (severe vs mild to moderate, P = .03), and hepatic metabolic and synthetic function (no fibrosis vs intermediate fibrosis, P ≤ .01). CONCLUSION In a general clinical practice environment, hepatic MR elastography is a robust imaging method with a high success rate in a broad spectrum of patients. It also shows the complex association between liver stiffness and hepatic pathophysiology.
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Affiliation(s)
- Meng Yin
- From the Departments of Radiology (M.Y., K.J.G., J.C., A.M., R.L.E.) and Gastroenterology (J.A.T.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Kevin J Glaser
- From the Departments of Radiology (M.Y., K.J.G., J.C., A.M., R.L.E.) and Gastroenterology (J.A.T.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Jayant A Talwalkar
- From the Departments of Radiology (M.Y., K.J.G., J.C., A.M., R.L.E.) and Gastroenterology (J.A.T.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Jun Chen
- From the Departments of Radiology (M.Y., K.J.G., J.C., A.M., R.L.E.) and Gastroenterology (J.A.T.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Armando Manduca
- From the Departments of Radiology (M.Y., K.J.G., J.C., A.M., R.L.E.) and Gastroenterology (J.A.T.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Richard L Ehman
- From the Departments of Radiology (M.Y., K.J.G., J.C., A.M., R.L.E.) and Gastroenterology (J.A.T.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
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Venkatesh SK, Yin M, Takahashi N, Glockner JF, Talwalkar JA, Ehman RL. Non-invasive detection of liver fibrosis: MR imaging features vs. MR elastography. ABDOMINAL IMAGING 2015; 40:766-775. [PMID: 25805619 PMCID: PMC4739358 DOI: 10.1007/s00261-015-0347-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To compare accuracy of morphological features of liver on MRI and liver stiffness with MR elastography (MRE) for detection of significant liver fibrosis and cirrhosis. MATERIALS AND METHODS In this retrospective study, we evaluated 62 patients who underwent liver MRI with MRE and histological confirmation of liver fibrosis within 6 months. Two radiologists, blinded to histology results, independently evaluated liver parenchyma texture, surface nodularity, signs of volumetric changes, and portal hypertension for presence of significant fibrosis and cirrhosis. Two more readers independently calculated mean liver stiffness values with MRE. Interobserver agreement was evaluated with kappa and intra-class correlation coefficient (ICC) analysis. Diagnostic accuracy was assessed with area under receiver operating characteristic (AUROC) analysis. Comparison of AUROCs of MRI and MRE was performed. RESULTS Liver fibrosis was present in 37 patients. The interobserver agreement was poor to good (κ = 0.12-0.74) for MRI features and excellent for MRE (ICC 0.97, 95% CI 0.95-0.98). MRI features had 48.5%-87.9% sensitivity, 55.2%-100% specificity, and 71.5%-81.6% accuracy/for detection of significant fibrosis. MRE performed better with 100% sensitivity, 96.5% specificity, and 98.9% accuracy. For the detection of cirrhosis, MRE performed better than MRI features with 88.2% sensitivity (vs. 41.2%-82.3%), 91.1% specificity (vs. 64.4%-95.6%), and 93.5% accuracy (vs. 60.6%-80.5%). Among the MRI features, surface nodularity and overall impression had the best accuracies of 80.3% and 81.6% for detection of significant fibrosis, respectively. For cirrhosis, parenchyma texture and overall impression had the best accuracies of 80.5% and 79.7%, respectively. Overall, MRE had significantly greater AUROC than MRI features for detection of both significant fibrosis (0.98.9 vs 0.71-0.82, P < 0.001) and cirrhosis (0.93.5 vs. 0.61-0.80.5, P < 0.01). CONCLUSION MRE is superior to MRI for the non-invasive diagnosis of significant liver fibrosis and cirrhosis.
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Affiliation(s)
- Sudhakar K Venkatesh
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, 55905, MN, USA,
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Abstract
Many diseases cause substantial changes in the mechanical properties of tissue, and this provides motivation for developing methods to noninvasively assess the stiffness of tissue using imaging technology. Magnetic resonance elastography (MRE) has emerged as a versatile MRI-based technique, based on direct visualization of propagating shear waves in the tissues. The most established clinical application of MRE in the abdomen is in chronic liver disease. MRE is currently regarded as the most accurate noninvasive technique for detection and staging of liver fibrosis. Increasing experience and ongoing research is leading to exploration of applications in other abdominal organs. In this review article, the current use of MRE in liver disease and the potential future applications of this technology in other parts of the abdomen are surveyed.
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Singh S, Venkatesh SK, Wang Z, Miller FH, Motosugi U, Low RN, Hassanein T, Asbach P, Godfrey EM, Yin M, Chen J, Keaveny AP, Bridges M, Bohte A, Murad MH, Lomas DJ, Talwalkar JA, Ehman RL. Diagnostic performance of magnetic resonance elastography in staging liver fibrosis: a systematic review and meta-analysis of individual participant data. Clin Gastroenterol Hepatol 2015; 13:440-451.e6. [PMID: 25305349 PMCID: PMC4333001 DOI: 10.1016/j.cgh.2014.09.046] [Citation(s) in RCA: 412] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 09/12/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Magnetic resonance elastography (MRE) is a noninvasive tool for staging liver fibrosis. We conducted a meta-analysis of individual participant data collected from published studies to assess the diagnostic accuracy of MRE for staging liver fibrosis in patients with chronic liver diseases (CLD). METHODS Through a systematic literature search of multiple databases (2003-2013), we identified studies on diagnostic performance of MRE for staging liver fibrosis in patients with CLD with native anatomy, using liver biopsy as the standard. We contacted study authors to collect data on each participant's age, sex, body mass index (BMI), liver stiffness (measured by MRE), fibrosis stage, staging system used, degree of inflammation, etiology of CLD, and interval between MRE and biopsy. Through a pooled analysis, we calculated cluster-adjusted area under the receiver-operating curve, sensitivity, and specificity of MRE for any fibrosis (≥stage 1), significant fibrosis (≥stage 2), advanced fibrosis (≥stage 3), and cirrhosis (stage 4). RESULTS We analyzed data from 12 retrospective studies, comprising 697 patients (mean age, 55 ± 13 y; 59.4% male; mean BMI, 26.9 ± 6.7 kg/m(2); 92.1% with <1 year interval between MRE and biopsy; and 47.1% with hepatitis C). Overall, 19.5%, 19.4%, 15.5%, 15.9%, and 29.7% patients had stage 0, 1, 2, 3, and 4 fibrosis, respectively. The mean area under the receiver-operating curve values (and 95% confidence intervals) for the diagnosis of any (≥stage 1), significant (≥stage 2), advanced fibrosis (≥stage 3), and cirrhosis, were as follows: 0.84 (0.76-0.92), 0.88 (0.84-0.91), 0.93 (0.90-0.95), and 0.92 (0.90-0.94), respectively. A similar diagnostic performance was observed in stratified analysis based on sex, obesity, and etiology of CLD. The overall rate of failure of MRE was 4.3%. CONCLUSIONS Based on a pooled analysis of data from individual participants, MRE has a high accuracy for the diagnosis of significant or advanced fibrosis and cirrhosis, independent of BMI and etiology of CLD. Prospective studies are warranted to better understand the diagnostic performance of MRE.
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Affiliation(s)
- Siddharth Singh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | | | - Zhen Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Frank H Miller
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Utaroh Motosugi
- Department of Radiology, University of Yamanashi, Chuo-shi, Yamanashi, Japan
| | - Russell N Low
- Sharp and Children's Magnetic Resonance Imaging Center, San Diego, California
| | | | - Patrick Asbach
- Department of Radiology, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
| | - Edmund M Godfrey
- Department of Radiology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Meng Yin
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Jun Chen
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | - Mellena Bridges
- Department of Radiology, Department of Medicine, Mayo Clinic, Jacksonville, Florida
| | - Anneloes Bohte
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Mohammad Hassan Murad
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - David J Lomas
- Department of Radiology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Jayant A Talwalkar
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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Luersen GF, Bhosale P, Szklaruk J. State-of-the-art cross-sectional liver imaging: beyond lesion detection and characterization. J Hepatocell Carcinoma 2015; 2:101-17. [PMID: 27508199 PMCID: PMC4918289 DOI: 10.2147/jhc.s85201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Cross-sectional imaging with computed tomography or magnetic resonance imaging is routinely used to detect and diagnose liver lesions; however, these examinations can provide additional important information. The improvement of equipment and techniques has allowed outstanding evaluation of the vascular and biliary anatomy, which is practicable in most routine examinations. Anatomical variants may exclude patients from certain therapeutic options and may be the cause of morbidity or mortality after surgery or interventional procedures. Diffuse liver disease, such as steatosis, hemochromatosis, or fibrosis, must be diagnosed and quantified. Usually these conditions are silent until the late stages, and imaging plays an important role in detecting them early. Additionally, a background of diffuse disease may interfere in a focal lesion systematic reasoning. The diagnostic probability of a particular nodule varies according to the background liver disease. Nowadays, most diffuse liver diseases can be easily and accurately quantified by imaging, which has allowed better understanding of these diseases and improved patient management. Finally, cross-sectional imaging can calculate total and partial liver volumes and estimate the future liver remnant after hepatectomy. This information helps to select patients for portal vein embolization and reduces postoperative complications. Use of a specific hepatic contrast agent on magnetic resonance imaging, in addition to improving detection and characterization of focal lesions, provides functional global and segmental information about the liver parenchyma.
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Affiliation(s)
- Gustavo Felipe Luersen
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Priya Bhosale
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Janio Szklaruk
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Li BN, Shan X, Xiang K, An N, Xu J, Huang W, Kobayashi E. Evaluation of robust wave image processing methods for magnetic resonance elastography. Comput Biol Med 2014; 54:100-8. [DOI: 10.1016/j.compbiomed.2014.08.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 08/20/2014] [Accepted: 08/22/2014] [Indexed: 01/22/2023]
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Su LN, Guo SL, Li BX, Yang P. Diagnostic value of magnetic resonance elastography for detecting and staging of hepatic fibrosis: a meta-analysis. Clin Radiol 2014; 69:e545-52. [PMID: 25300557 DOI: 10.1016/j.crad.2014.09.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 08/25/2014] [Accepted: 09/04/2014] [Indexed: 12/26/2022]
Abstract
AIM A meta-analysis was performed to evaluate the diagnostic value of magnetic resonance elastography (MRE) in detecting and staging hepatic fibrosis. MATERIALS AND METHODS A systematic search of PubMed, EMBASE, Web of Science, and Cochrane Library Database up to October 2013 was undertaken to find studies on the evaluation of MRE in patients suspected of hepatic fibrosis. Data from the articles were analysed using Meta-disc 1.4 and Stata 12.0 software. The sensitivity, specificity, and area under the summary receiver operating characteristic (ROC) curve (AUROC) were pooled for all stages of hepatic fibrosis (F ≥ 1, F ≥ 2, F ≥ 3, and F = 4). Publication bias was assessed through the Deeks' funnel plot asymmetry tests. RESULTS Thirteen studies comprising 989 patients met the inclusion criteria. The pooled sensitivity and specificity for F ≥ 1, F ≥ 2, F ≥ 3, and F = 4 were 0.87 (95% CI = 0.84-0.89) and 0.92 (95% CI = 0.87-0.96), 0.87 (95% CI = 0.84-0.90) and 0.92 (95% CI = 0.89-0.95), 0.88 (95% CI = 0.85-0.91) and 0.91 (95% CI = 0.88-0.93), 0.91 (95% CI = 0.87-0.94) and 0.92 (95% CI = 0.89-0.94), respectively. The pooled AUROC for F ≥ 1, F ≥ 2, F ≥ 3, and F = 4 were 0.9502, 0.9663, 0.9644, and 0.9768, respectively. The non-significant slope of Deeks' funnel plot asymmetry tests indicated that no significant bias was found. CONCLUSIONS MRE has a high diagnostic accuracy for the quantitative detection and staging of hepatic fibrosis.
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Affiliation(s)
- L-N Su
- Department of Radiology, The First Clinical Medical School of Lanzhou University, Lanzhou 730000, China
| | - S-L Guo
- Department of Radiology, The First Clinical Medical School of Lanzhou University, Lanzhou 730000, China.
| | - B-X Li
- Department of Radiology, The First Clinical Medical School of Lanzhou University, Lanzhou 730000, China
| | - P Yang
- Department of Radiology, The First Clinical Medical School of Lanzhou University, Lanzhou 730000, China
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Characterization of fortuitously discovered focal liver lesions: additional information provided by shearwave elastography. Eur Radiol 2014; 25:346-58. [PMID: 25231131 DOI: 10.1007/s00330-014-3370-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 06/24/2014] [Accepted: 07/21/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To prospectively assess the stiffness of incidentally discovered focal liver lesions (FLL) with no history of chronic liver disease or extrahepatic cancer using shearwave elastography (SWE). METHODS Between June 2011 and May 2012, all FLL fortuitously discovered on ultrasound examination were prospectively included. For each lesion, stiffness was measured (kPa). Characterization of the lesion relied on magnetic resonance imaging (MRI) and/or contrast-enhanced ultrasound, or biopsy. Tumour stiffness was analysed using ANOVA and non-parametric Mann-Whitney tests. RESULTS 105 lesions were successfully evaluated in 73 patients (61 women, 84%) with a mean age of 44.8 (range: 20‒75). The mean stiffness was 33.3 ± 12.7 kPa for the 60 focal nodular hyperplasia (FNH), 19.7 ± 9.8 k Pa for the 17 hepatocellular adenomas (HCA), 17.1 ± 7 kPa for the 20 haemangiomas, 11.3 ± 4.3 kPa for the five focal fatty sparing, 34.1 ± 7.3 kPa for the two cholangiocarcinomas, and 19.6 kPa for one hepatocellular carcinoma (p < 0.0001). There was no difference between the benign and the malignant groups (p = 0.64). FNHs were significantly stiffer than HCAs (p < 0.0001). Telangiectatic/inflammatory HCAs were significantly stiffer than the steatotic HCAs (p = 0.014). The area under the ROC curve (AUROC) for differentiating FNH from other lesions was 0.86 ± 0.04. CONCLUSION SWE may provide additional information for the characterization of FFL, and may help in differentiating FNH from HCAs, and in subtyping HCAs. KEY POINTS • SWE might be helpful for the characterization of solid focal liver lesions • SWE cannot differentiate benign from malignant liver lesions • FNHs are significantly stiffer than other benign lesions • Telangiectatic/inflammatory HCA are significantly stiffer than steatotic ones.
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Abstract
Magnetic resonance elastography (MRE) assesses tissue stiffness in vivo by imaging propagating shear waves through the tissues and processing the wave information. MRE is a robust technology with excellent technical success; is applicable in almost all patients and body habitus; and has excellent reproducibility, repeatability, and interobserver agreement for assessing liver stiffness. It is currently the most accurate noninvasive technique for detection and staging of liver fibrosis and has the potential to replace liver biopsy. This article describes the principles and technique of MRE, current clinical applications, and emerging clinical indications.
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Affiliation(s)
- Sudhakar Kundapur Venkatesh
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Richard L Ehman
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Huang SY, Abdelsalam ME, Harmoush S, Ensor JE, Chetta JA, Hwang KP, Stafford RJ, Madoff DC, Avritscher R. Evaluation of liver fibrosis and hepatic venous pressure gradient with MR elastography in a novel swine model of cirrhosis. J Magn Reson Imaging 2014; 39:590-7. [PMID: 24532376 DOI: 10.1002/jmri.24189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 04/03/2013] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To assess the correlation among MR elastography (MRE) measured liver stiffness (LS), liver fibrosis, and hepatic venous pressure gradient (HVPG) in a swine model of cirrhosis. MATERIALS AND METHODS Three swine served as controls, and liver fibrosis was induced in eight swine by transarterial embolization. LS and HVPG were obtained at baseline and 4 weeks (prenecropsy) following induction of liver fibrosis. RESULTS Four weeks following the induction of liver cirrhosis, experimental animals developed an increase in HVPG of 8.0±6.4 mmHg compared with 0.3±1.2 mmHg for controls (P=0.08). Over the same timeframe, mean MRE-measured LS increased 0.82±0.39 kPa for experimental swine and 0.1±0.05 kPa for controls (P=0.01). A positive correlation was observed between increases in HVPG and LS (ρ=0.682; P=0.02). Liver fibrosis was measured on explanted livers at 4 weeks and yielded mean fibrosis scores of 2.8 for experimental animals and 0 for controls (P=0.0016). A positive correlation was observed between higher LS and liver fibrosis (ρ=0.884; P=0.0003). CONCLUSION MRE is a reliable noninvasive technique to measure LS in a swine model of cirrhosis. Significant positive correlations were observed between LS and HVPG as well as LS and fibrosis.
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Affiliation(s)
- Steven Y Huang
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Abstract
Magnetic resonance elastography (MRE) has been successfully implemented in the assessment of diffuse liver diseases. Currently, MRE is the most accurate noninvasive technique for detection and staging of liver fibrosis with a potential to replace liver biopsy. Magnetic resonance elastography is able to differentiate isolated fatty liver disease from steatohepatitis with or without fibrosis. Potential clinical applications include the differentiation of benign and malignant focal liver masses and the assessment of treatment response in diffuse liver diseases.
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Garteiser P, Sahebjavaher RS, Ter Beek LC, Salcudean S, Vilgrain V, Van Beers BE, Sinkus R. Rapid acquisition of multifrequency, multislice and multidirectional MR elastography data with a fractionally encoded gradient echo sequence. NMR IN BIOMEDICINE 2013; 26:1326-35. [PMID: 23712852 DOI: 10.1002/nbm.2958] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 03/08/2013] [Accepted: 03/08/2013] [Indexed: 05/16/2023]
Abstract
In MR elastography (MRE), periodic tissue motion is phase encoded using motion-encoding gradients synchronized to an externally applied periodic mechanical excitation. Conventional methods result in extended scan time for quality phase images, thus limiting the broad application of MRE in the clinic. For practical scan times, researchers have been relying on one-dimensional or two-dimensional motion-encoding, low-phase sampling and a limited number of slices, and artifact-prone, single-shot, echo planar imaging (EPI) readout. Here, we introduce a rapid multislice pulse sequence capable of three-dimensional motion encoding that is also suitable for simultaneously encoding motion with multiple frequency components. This sequence is based on a gradient-recalled echo (GRE) sequence and exploits the principles of fractional encoding. This GRE MRE pulse sequence was validated as capable of acquiring full three-dimensional motion encoding of isotropic voxels in a large volume within less than a minute. This sequence is suitable for monofrequency and multifrequency MRE experiments. In homogeneous paraffin phantoms, the eXpresso sequence yielded similar storage modulus values as those obtained with conventional methods, although with markedly reduced variances (7.11 ± 0.26 kPa for GRE MRE versus 7.16 ± 1.33 kPa for the conventional spin-echo EPI sequence). The GRE MRE sequence obtained better phase-to-noise ratios than the equivalent spin-echo EPI sequence (matched for identical acquisition time) in both paraffin phantoms and in vivo data in the liver (59.62 ± 11.89 versus 27.86 ± 3.81, 61.49 ± 14.16 versus 24.78 ± 2.48 and 58.23 ± 10.39 versus 23.48 ± 2.91 in the X, Y and Z components, respectively, in the case of liver experiments). Phase-to-noise ratios were similar between GRE MRE used in monofrequency or multifrequency experiments (75.39 ± 14.93 versus 86.13 ± 18.25 at 28 Hz, 71.52 ± 24.74 versus 86.96 ± 30.53 at 56 Hz and 95.60 ± 36.96 versus 61.35 ± 26.25 at 84Hz, respectively).
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Numano T, Kawabata Y, Mizuhara K, Washio T, Nitta N, Homma K. Magnetic resonance elastography using an air ball-actuator. Magn Reson Imaging 2013; 31:939-46. [DOI: 10.1016/j.mri.2013.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 01/23/2013] [Accepted: 02/20/2013] [Indexed: 11/26/2022]
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Venkatesh SK, Yin M, Ehman RL. Magnetic resonance elastography of liver: technique, analysis, and clinical applications. J Magn Reson Imaging 2013; 37:544-55. [PMID: 23423795 PMCID: PMC3579218 DOI: 10.1002/jmri.23731] [Citation(s) in RCA: 497] [Impact Index Per Article: 41.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 05/10/2012] [Indexed: 12/12/2022] Open
Abstract
Many pathological processes cause marked changes in the mechanical properties of tissue. MR elastography (MRE) is a noninvasive MRI based technique for quantitatively assessing the mechanical properties of tissues in vivo. MRE is performed by using a vibration source to generate low frequency mechanical waves in tissue, imaging the propagating waves using a phase contrast MRI technique, and then processing the wave information to generate quantitative images showing mechanical properties such as tissue stiffness. Since its first description in 1995, published studies have explored many potential clinical applications including brain, thyroid, lung, heart, breast, and skeletal muscle imaging. However, the best-documented application to emerge has been the use of MRE to assess liver disease. Multiple studies have demonstrated that there is a strong correlation between MRE-measured hepatic stiffness and the stage of fibrosis at histology. The emerging literature indicates that MRE can serve as a safer, less expensive, and potentially more accurate alternative to invasive liver biopsy which is currently the gold standard for diagnosis and staging of liver fibrosis. This review describes the basic principles, technique of performing a liver MRE, analysis and calculation of stiffness, clinical applications, limitations, and potential future applications.
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Affiliation(s)
| | - Meng Yin
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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de Souza DAT, Parente DB, de Araújo ALE, Mortelé KJ. Modern imaging evaluation of the liver: emerging MR imaging techniques and indications. Magn Reson Imaging Clin N Am 2013; 21:337-63. [PMID: 23642557 DOI: 10.1016/j.mric.2013.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Modern MR imaging evaluation of the liver allows for a comprehensive morphologic and functional assessment of the liver parenchyma, hepatic vessels, and biliary tree, thus aiding in the diagnosis of both focal and diffuse liver diseases.
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Hirsch S, Guo J, Reiter R, Papazoglou S, Kroencke T, Braun J, Sack I. MR Elastography of the Liver and the Spleen Using a Piezoelectric Driver, Single-Shot Wave-Field Acquisition, and Multifrequency Dual Parameter Reconstruction. Magn Reson Med 2013; 71:267-77. [DOI: 10.1002/mrm.24674] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 01/10/2013] [Accepted: 01/10/2013] [Indexed: 12/19/2022]
Affiliation(s)
- Sebastian Hirsch
- Department of Radiology; Charité-Universitätsmedizin Berlin, Campus Charité Mitte; Berlin Germany
| | - Jing Guo
- Department of Radiology; Charité-Universitätsmedizin Berlin, Campus Charité Mitte; Berlin Germany
| | - Rolf Reiter
- Department of Radiology; Charité-Universitätsmedizin Berlin, Campus Charité Mitte; Berlin Germany
| | - Sebastian Papazoglou
- Department of Radiology; Charité-Universitätsmedizin Berlin, Campus Charité Mitte; Berlin Germany
| | - Thomas Kroencke
- Department of Radiology; Charité-Universitätsmedizin Berlin, Campus Charité Mitte; Berlin Germany
| | - Juergen Braun
- Institute of Medical Informatics; Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin; Berlin Germany
| | - Ingolf Sack
- Department of Radiology; Charité-Universitätsmedizin Berlin, Campus Charité Mitte; Berlin Germany
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48
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Abstract
Anatomical-based imaging is used widely for the evaluation of diffuse and focal liver, including detection, characterization, and therapy response assessment. However, a limitation of anatomical-based imaging is that structural changes may occur relatively late in a disease process. By applying conventional anatomical-imaging methods in a more functional manner, specific pathophysiologic alterations of the liver may be assessed and quantified. There has been an increasing interest in both the clinical and research settings, with the expectation that functional-imaging techniques may help solve common diagnostic dilemmas that conventional imaging alone cannot. This review considers the most common functional magnetic resonance imaging, computed tomography, and ultrasound imaging techniques that may be applied to the liver.
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Affiliation(s)
- Vicky Goh
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
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49
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Godfrey EM, Mannelli L, Griffin N, Lomas DJ. Magnetic resonance elastography in the diagnosis of hepatic fibrosis. Semin Ultrasound CT MR 2013; 34:81-88. [PMID: 23395320 DOI: 10.1053/j.sult.2012.11.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Liver fibrosis is a common feature of many chronic liver diseases, and can ultimately progress to cirrhosis. Conventional imaging is insensitive to liver fibrosis, necessitating a liver biopsy for diagnosis and monitoring of progression. However, liver biopsy risks complications, and is an imperfect gold standard in view of sampling error and intraobserver or interobserver variation. Magnetic resonance elastography (MRE) is a noninvasive method for assessing the mechanical properties of tissues and is gaining credence as a method of assessment for hepatic fibrosis. The aim of this review is to describe how MRE is performed, to review the present literature on the subject, to compare MRE with other noninvasive techniques used to assess for liver fibrosis, and to highlight areas of future research.
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Affiliation(s)
- Edmund M Godfrey
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, UK.
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Bahl G, Cruite I, Wolfson T, Gamst AC, Collins JM, Chavez AD, Barakat F, Hassanein T, Sirlin CB. Noninvasive classification of hepatic fibrosis based on texture parameters from double contrast-enhanced magnetic resonance images. J Magn Reson Imaging 2012; 36:1154-61. [PMID: 22851409 DOI: 10.1002/jmri.23759] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 06/19/2012] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To demonstrate a proof of concept that quantitative texture feature analysis of double contrast-enhanced magnetic resonance imaging (MRI) can classify fibrosis noninvasively, using histology as a reference standard. MATERIALS AND METHODS A Health Insurance Portability and Accountability Act (HIPAA)-compliant Institutional Review Board (IRB)-approved retrospective study of 68 patients with diffuse liver disease was performed at a tertiary liver center. All patients underwent double contrast-enhanced MRI, with histopathology-based staging of fibrosis obtained within 12 months of imaging. The MaZda software program was used to compute 279 texture parameters for each image. A statistical regularization technique, generalized linear model (GLM)-path, was used to develop a model based on texture features for dichotomous classification of fibrosis category (F ≤2 vs. F ≥3) of the 68 patients, with histology as the reference standard. The model's performance was assessed and cross-validated. There was no additional validation performed on an independent cohort. RESULTS Cross-validated sensitivity, specificity, and total accuracy of the texture feature model in classifying fibrosis were 91.9%, 83.9%, and 88.2%, respectively. CONCLUSION This study shows proof of concept that accurate, noninvasive classification of liver fibrosis is possible by applying quantitative texture analysis to double contrast-enhanced MRI. Further studies are needed in independent cohorts of subjects.
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Affiliation(s)
- Gautam Bahl
- University of California, San Diego, Department of Radiology, San Diego, California 92103, USA
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