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Abe R, Fukuzawa K, Yoshihara C, Tano M, Saitoh S. Comparison of spin-echo echo planar imaging and gradient-recalled echo sequences in magnetic resonance elastography of liver at 1.5T same MRI scanner. Abdom Radiol (NY) 2024; 49:694-702. [PMID: 38012395 DOI: 10.1007/s00261-023-04098-3] [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: 06/23/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE Magnetic resonance elastography (MRE) is used to measure liver stiffness with gradient-recalled echo (GRE)-based and spin-echo echo planar imaging (SE-EPI)-based sequences. We compared the liver stiffness (LS) values of the two sequences on a 1.5-T MR imaging scanner. METHODS This is a retrospective study. An MRE imaging section was obtained from a horizontal section of the liver. Region of interest was drawn on the elastogram, and the mean LS and pixel values were measured and compared. The correlations between proton density fat fraction, R2* values, and biochemical data from electronic medical records were confirmed, and multivariate analysis was performed. RESULTS The mean LS values were 3.01 ± 1.78 kPa for GRE and 3.13 ± 1.57 kPa for SE-EPI, showing excellent agreement and a strong correlation between the two sequences (correlation coefficient r = 0.96). The mean pixel values were 369.5 ± 142.7 pixels for GRE and 490.1 ± 197.9 pixels for SE-EPI, showing a significant difference by the Wilcoxon rank sum test (p < 0.01). There were no LS unmeasurable cases in SE-EPI, but seven (2.5%) were unmeasurable in GRE, and multivariate analysis showed a significant difference with p < 0.001 in R2* values (mean, 92.7 Hz) for the GRE method. CONCLUSION The GRE and SE-EPI methods were comparable for LS measurements in 1.5-T liver MRE, indicating that SE-EPI MRE is more useful because GRE MRE may not measure cases with high R2* values and the region of interest tends to be smaller.
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Affiliation(s)
- Ryouna Abe
- Department of Radiological Technology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, Japan.
| | - Kei Fukuzawa
- Department of Radiological Technology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, Japan
| | - Chiharu Yoshihara
- Department of Radiological Technology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, Japan
| | - Masakatsu Tano
- Department of Radiological Technology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, Japan
| | - Satoshi Saitoh
- Department of Hepatology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, Japan
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Jang W, Jo S, Song JS, Hwang HP, Kim SH. Correction to: Comparison of diffusion‑weighted imaging and MR elastography in staging liver fibrosis: a meta‑analysis. Abdom Radiol (NY) 2023; 48:2763-2768. [PMID: 37231220 DOI: 10.1007/s00261-023-03942-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Weon Jang
- Department of Radiology, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea
- Biomedical Research Institute of Jeonbuk National University Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, Jeonbuk, 54907, Korea
| | - Seongil Jo
- Department of Statistics, Inha University, Incheon, Korea
| | - Ji Soo Song
- Department of Radiology, Jeonbuk National University Medical School and Hospital, Jeonju, Korea.
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea.
- Biomedical Research Institute of Jeonbuk National University Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, Jeonbuk, 54907, Korea.
| | - Hong Pil Hwang
- Department of Surgery, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Seong-Hun Kim
- Department of Internal Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
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Schambeck JPL, Forte GC, Gonçalves LM, Stuker G, Kotlinski JBF, Tramontin G, Altmayer S, Watte G, Hochhegger B. Diagnostic accuracy of magnetic resonance elastography and point-shear wave elastography for significant hepatic fibrosis screening: Systematic review and meta-analysis. PLoS One 2023; 18:e0271572. [PMID: 36730265 PMCID: PMC9894488 DOI: 10.1371/journal.pone.0271572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 07/03/2022] [Indexed: 02/03/2023] Open
Abstract
The hepatic diseases are extremely common in clinical practice. The correct classification of liver fibrosis is extremely important, as it influences therapy and predicts disease outcomes. The purpose of this study is to compare the diagnostic performance of point-shear wave elastography (pSWE) and magnetic resonance elastography (MRE) in the hepatic fibrosis diagnostic. A meta-analysis was carried out based on articles published until October 2020. The articles are available at following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Scientific Electronic Library Online, LILACS, Scopus, and CINAHL. Diagnostic performances were analyzed per METAVIR F2, using 3.5kPa as target fibrosis. Assessment of the methodological quality of the incorporated papers by the QUADAS-2 tool for pSWE and MRE. A total 2,153 studies articles were evaluated and 44 studies, comprising 6,081 patients with individual data, were included in the meta-analysis: 28 studies for pSWE and 16 studies for MRE. The pooled sensitivity and specificity were 0.86 (95%CI 0.80-0.90) and 0.88 (95%CI 0.85-0.91), respectively, for pSWE, compared with 0.94 (95%CI 0.89-0.97) and 0.95 (95%CI 0.89-0.98) respectively, for MRE. The pooled SROC curve for pSWE shows in the area under the curve (AUC) of 0.93 (95%CI 0.90-0.95), whereas the AUC for MRE was 0.98 (95%CI 0.96-0.99). The diagnostic odds ratio for pSWE and MRE were 41 (95%CI 24-72) and 293 (95%CI 86-1000), respectively. There was statistically significant heterogeneity for pSWE sensitivity (I² = 85.26, P<0.001) and specificity (I² = 89.46, P<0.001). The heterogeneity for MRE also was significant for sensitivity (I² = 73.28, P<0.001) and specificity (I² = 87.24, P<0.001). Therefore, both pSWE and MRE are suitable modalities for assessing liver fibrosis. In addition, MRE is a more accurate imaging technique than pSWE and can be used as alternative to invasive biopsy.
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Affiliation(s)
- João Paulo L. Schambeck
- Post-Graduate Program in Medicine and Health Science, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Departament of Radiology, Hospital São Lucas/Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gabriele C. Forte
- Departament of Radiology, Hospital São Lucas/Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Faculty of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- * E-mail:
| | - Luana M. Gonçalves
- Post-Graduate Program in Medicine and Health Science, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Departament of Radiology, Hospital São Lucas/Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Guilherme Stuker
- Departament of Radiology, Hospital São Lucas/Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - João Bruno F. Kotlinski
- Faculty of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Giacomo Tramontin
- Departament of Radiology, Hospital São Lucas/Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Stephan Altmayer
- Post-Graduate Program in Medicine and Health Science, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Guilherme Watte
- Department of Radiology, Medical Imaging Research Lab, LABIMED, Porto Alegre, Rio Grande do Sul, Brazil
| | - Bruno Hochhegger
- Post-Graduate Program in Medicine and Health Science, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Departament of Radiology, Hospital São Lucas/Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Department of Radiology, Medical Imaging Research Lab, LABIMED, Porto Alegre, Rio Grande do Sul, Brazil
- Department of Diagnostic Methods, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Kim SW, Lee JM, Park S, Joo I, Yoon JH, Chang W, Kim H. Diagnostic Performance of Spin-Echo Echo-Planar Imaging Magnetic Resonance Elastography in 3T System for Noninvasive Assessment of Hepatic Fibrosis. Korean J Radiol 2022; 23:180-188. [PMID: 35029070 PMCID: PMC8814695 DOI: 10.3348/kjr.2021.0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 08/08/2021] [Accepted: 08/09/2021] [Indexed: 11/15/2022] Open
Abstract
Objective To validate the performance of 3T spin-echo echo-planar imaging (SE-EPI) magnetic resonance elastography (MRE) for staging hepatic fibrosis in a large population, using surgical specimens as the reference standard. Materials and Methods This retrospective study initially included 310 adults (155 undergoing hepatic resection and 155 undergoing donor hepatectomy) with histopathologic results from surgical liver specimens. They underwent 3T SE-EPI MRE ≤ 3 months prior to surgery. Demographic findings, underlying liver disease, and hepatic fibrosis pathologic stage according to METAVIR were recorded. Liver stiffness (LS) was measured by two radiologists, and inter-reader reproducibility was evaluated using the intraclass correlation coefficient (ICC). The mean LS of each fibrosis stage (F0–F4) was calculated in total and for each etiologic subgroup. Comparisons among subgroups were performed using the Kruskal–Wallis test and Conover post-hoc test. The cutoff values for fibrosis staging were estimated using receiver operating characteristic (ROC) curve analysis. Results Inter-reader reproducibility was excellent (ICC, 0.98; 95% confidence interval, 0.97–0.99). The mean LS values were 1.91, 2.41, 3.24, and 5.41 kPa in F0–F1 (n = 171), F2 (n = 26), F3 (n = 38), and F4 (n = 72), respectively. The discriminating cutoff values for diagnosing ≥ F2, ≥ F3, and F4 were 2.18, 2.71, and 3.15 kPa, respectively, with the ROC curve areas of 0.97–0.98 (sensitivity 91.2%–95.9%, specificity 90.7%–99.0%). The mean LS was significantly higher in patients with cirrhosis (F4) of nonviral causes, such as primary biliary cirrhosis (9.56 kPa) and alcoholic liver disease (7.17 kPa) than in those with hepatitis B or C cirrhosis (4.28 and 4.92 kPa, respectively). There were no statistically significant differences in LS among the different etiologic subgroups in the F0–F3 stages. Conclusion The 3T SE-EPI MRE demonstrated high interobserver reproducibility, and our criteria for staging hepatic fibrosis showed high diagnostic performance. LS was significantly higher in patients with non-viral cirrhosis than in those with viral cirrhosis.
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Affiliation(s)
- Se Woo Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul National University Hospital, Seoul, Korea.
| | - Sungeun Park
- Department of Radiology, Konkuk University Medical Center, Seoul, Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Won Chang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Haeryoung Kim
- Department of Pathology, Seoul National University Hospital, Seoul, Korea.,Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
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Evaluation of Rabbits Liver Fibrosis Using Gd-DTPA-BMA of Dynamic Contrast-Enhanced Magnetic Resonance Imaging. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:2791142. [PMID: 34567208 PMCID: PMC8463207 DOI: 10.1155/2021/2791142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 08/25/2021] [Accepted: 09/03/2021] [Indexed: 11/17/2022]
Abstract
Objective To evaluate the different pharmacokinetic parameters of the DCE-MRI method on diagnosing and staging of rabbits' liver fibrosis. Methods We had performed DCE-MRI for rabbits that had been divided into the experiment group and the control group. Then, rabbits' images were transferred to a work station to get three parameters such as K trans, K ep, and V e, which had been measured to calculate. After data were analyzed, ROC analyses were performed to assess the diagnostic performance of K trans, K ep, and V e to judge liver fibrosis. Results The distribution of the different liver fibrosis group was as follows: F1, n = 8; F2, n = 9; F3, n = 6; F4, n = 5. No fibrosis was deemed as F0, n = 6. K ep is statistically significant (P < 0.05) for F0 and mild liver fibrosis stage, and the K ep shows AUC of 0.814. Three parameters are statistically significant for F0 and advanced liver fibrosis stage (K trans and K ep, P < 0.01; V e, P < 0.05), and the K trans shows AUC of 0.924; the K ep shows AUC of 0.909; the V e shows AUC of 0.848; K trans and K ep are statistically significant for mild and advanced liver fibrosis stages (K trans, P < 0.01; K ep, P < 0.05), and the K trans shows AUC of 0.840; the K ep shows AUC of 0.765. Both K trans and K ep are negatively correlated with the liver fibrosis stage. V e is positively correlated with the liver fibrosis stage. Conclusion K trans is shown to be the best DCE parameter to distinguish the fibrotic liver from the normal liver and mild and advanced fibrosis. On the contrary, K ep is moderate and V e is worst. And K ep is a good DCE parameter to differentiate mild fibrosis from the normal liver.
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Comparison of diffusion-weighted imaging and MR elastography in staging liver fibrosis: a meta-analysis. Abdom Radiol (NY) 2021; 46:3889-3907. [PMID: 33770223 DOI: 10.1007/s00261-021-03055-2] [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: 09/22/2020] [Revised: 03/02/2021] [Accepted: 03/09/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare the diagnostic performance of diffusion-weighted imaging (DWI), gradient-recalled echo-based magnetic resonance elastography (GRE-MRE), and spin-echo echo-planar imaging-based MRE (SE-EPI-MRE) in liver fibrosis staging. METHODS A systematic literature search was done to collect studies on the performance of DWI, GRE-MRE, and SE-EPI-MRE for diagnosing liver fibrosis. Pooled sensitivity, specificity, diagnostic odds ratio, positive and negative likelihood ratio, and a summary receiver operating characteristic (ROC) curve were estimated with a bivariate random effects model. Subgroup analyses on various study characteristics were performed. RESULTS Sixty studies with a total of 6620 patients were included in the meta-analysis. Pooled sensitivity and specificity of GRE-MRE and SE-EPI-MRE showed high diagnostic accuracy and did not differ significantly. The area under the summary ROC curve for all stages of fibrosis differed significantly between DWI (0.83-0.88) and either GRE-MRE (0.95-0.97) or SE-EPI-MRE (0.95-0.99). Substantial heterogeneity was detected for all three imaging methods. CONCLUSIONS Both GRE-MRE and SE-EPI-MRE are highly accurate for detection of each liver fibrosis stage, with high potential to replace liver biopsy. Although DWI had a moderate accuracy in distinguishing liver fibrosis, it could be regarded as an alternative to MRE, since it is widely available and easily implemented in routine liver MRI.
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Effect of breath holding at the end of the inspiration and expiration phases on liver stiffness measured by 2D-MR elastography. Abdom Radiol (NY) 2021; 46:2516-2526. [PMID: 33386913 DOI: 10.1007/s00261-020-02893-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/27/2020] [Accepted: 12/04/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Evaluate the effect of breath holding at the end of the inspiration and expiration phases on the measurement of liver stiffness by 2D-MR elastography (MRE). METHODS The study included 61 subjects, of which 31 subjects were pathologically confirmed liver fibrosis patients [liver fibrosis group (LFG)] and 30 healthy subjects [healthy group (HG)]. MRE was used to measure the liver stiffness of subjects in inspiration breath-hold (IBH) and expiration breath-hold (EBH) states. RESULTS In IBH and EBH states, the liver stiffness measured by MRE was not significantly different in the HG (P = 0.125, > 0.05), while the LFG showed a significant difference (P <0.001). Also, a significant difference was observed between the change values in the mild/moderate fibrosis group (MFG) and advanced fibrosis group (AFG) (P = 0.005, < 0.05). CONCLUSIONS The liver stiffness values in patients with liver fibrosis were affected by breath-holding states. The higher the stage of liver fibrosis, the greater the change in liver stiffness values, but no significant difference was observed between liver stiffness values in healthy subjects under the two breath-holding conditions. Different breath-holding states are factors influencing liver fibrosis stiffness measured by MRE, which should be given due attention in both clinical and research contexts.
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MR elastography of the liver: comparison of three measurement methods. Clin Radiol 2020; 75:715.e1-715.e7. [DOI: 10.1016/j.crad.2020.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 05/07/2020] [Indexed: 02/07/2023]
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Kim HJ, Kim B, Yu HJ, Huh J, Lee JH, Lee SS, Kim KW, Kim JK. Reproducibility of hepatic MR elastography across field strengths, pulse sequences, scan intervals, and readers. Abdom Radiol (NY) 2020; 45:107-115. [PMID: 31720766 DOI: 10.1007/s00261-019-02312-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the reproducibility of hepatic MRE under various combinations of settings of field strength, pulse sequence, scan interval, and reader in non-alcoholic fatty liver disease (NAFLD) patients. METHODS Adult NAFLD patients were prospectively enrolled for serial hepatic MRE with 1.5 T using 2D GRE sequence and 3.0 T using 2D SE-EPI sequence on the same day and after 2 weeks, resulting a total of four MRE examinations per patient. Three readers with various levels of background knowledge in MRE technique and liver anatomy measured liver stiffness after a training session. Linear regression, Bland-Altman analysis, within-subject coefficient of variation, and reproducibility coefficient (RDC) were used to determine reproducibility of hepatic MRE measurement. RESULTS Twenty patients completed the MRE sessions. Liver stiffness through MRE showed pooled RDC of 26% (upper 95% CI 30.6%) and corresponding limits of agreement (LOA) within 0.55 kPa across field strengths, MRE sequences, and 2-week interscan interval in three readers. Small mean biases and narrow LOA were observed among readers (0.05-0.19 kPa ± 0.53). CONCLUSION The magnitude of change across combinations of scan parameters is within acceptable clinical range, rendering liver stiffness through MRE a reproducible quantitative imaging biomarker. A lower reproducibility was observed for measurements under different field strengths/MRE sequences at a longer (2 weeks) interscan interval. Operators should be trained to acquire region of interest consistently in repeat examinations.
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Affiliation(s)
- Hye Jin Kim
- Department of Radiology, Ajou University School of Medicine, Ajou University Hospital, 164 World cup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Bohyun Kim
- Department of Radiology, Ajou University School of Medicine, Ajou University Hospital, 164 World cup-ro, Yeongtong-gu, Suwon, 16499, South Korea.
| | - Hyun Jeong Yu
- Department of Radiology, Ajou University School of Medicine, Ajou University Hospital, 164 World cup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Jimi Huh
- Department of Radiology, Ajou University School of Medicine, Ajou University Hospital, 164 World cup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Jei Hee Lee
- Department of Radiology, Ajou University School of Medicine, Ajou University Hospital, 164 World cup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jai Keun Kim
- Department of Radiology, Ajou University School of Medicine, Ajou University Hospital, 164 World cup-ro, Yeongtong-gu, Suwon, 16499, South Korea
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Kim DW, Kim SY, Yoon HM, Kim KW, Byun JH. Comparison of technical failure of MR elastography for measuring liver stiffness between gradient‐recalled echo and spin‐echo echo‐planar imaging: A systematic review and meta‐analysis. J Magn Reson Imaging 2019; 51:1086-1102. [DOI: 10.1002/jmri.26918] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/14/2019] [Indexed: 12/14/2022] Open
Affiliation(s)
- Dong Wook Kim
- The Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical Center Seoul Republic of Korea
| | - So Yeon Kim
- The Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical Center Seoul Republic of Korea
| | - Hee Mang Yoon
- The Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical Center Seoul Republic of Korea
| | - Kyung Won Kim
- The Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical Center Seoul Republic of Korea
| | - Jae Ho Byun
- The Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical Center Seoul Republic of Korea
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Beziere N, Fuchs K, Maurer A, Reischl G, Brück J, Ghoreschi K, Fehrenbacher B, Berrio DC, Schenke-Layland K, Kohlhofer U, Quintanilla-Martinez L, Gawaz M, Kneilling M, Pichler B. Imaging fibrosis in inflammatory diseases: targeting the exposed extracellular matrix. Theranostics 2019; 9:2868-2881. [PMID: 31244929 PMCID: PMC6568181 DOI: 10.7150/thno.28892] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 12/10/2018] [Indexed: 01/09/2023] Open
Abstract
In a variety of diseases, from benign to life-threatening ones, inflammation plays a major role. Monitoring the intensity and extent of a multifaceted inflammatory process has become a cornerstone in diagnostics and therapy monitoring. However, the current tools lack the ability to provide insight into one of its most crucial aspects, namely, the alteration of the extracellular matrix (ECM). Using a radiolabeled platelet glycoprotein VI-based ECM-targeting fusion protein (GPVI-Fc), we investigated how binding of GPVI-Fc on fibrous tissue could uncover the progression of several inflammatory disease models at different stages (rheumatoid arthritis, cutaneous delayed-type hypersensitivity, lung inflammation and experimental autoimmune encephalomyelitis). Methods: The fusion protein GPVI-Fc was covalently linked to 1,4,7-triazacyclononane-1,4,7-triacetic acid (NOTA) and subsequently labeled with 64Cu. We analyzed noninvasively in vivo64Cu-GPVI-Fc accumulation in murine cutaneous delayed-type hypersensitivity, anti-glucose-6-phosphate isomerase serum-induced rheumatoid arthritis, lipopolysaccharide-induced lung inflammation and an experimental autoimmune encephalomyelitis model. Static and dynamic Positron Emission Tomography (PET) of the radiotracer distribution was performed in vivo, with ex vivo autoradiography confirmation, yielding quantitative accumulation and a distribution map of 64Cu-GPVI-Fc. Ex vivo tissue histological staining was performed on harvested samples to highlight the fusion protein binding to collagen I, II and III, fibronectin and fibrinogen as well as the morphology of excised tissue. Results:64Cu-GPVI-Fc showed a several-fold increased uptake in inflamed tissue compared to control tissue, particularly in the RA model, with a peak 24 h after radiotracer injection of up to half the injected dose. Blocking and isotype control experiments indicated a target-driven accumulation of the radiotracer in the case of chronic inflammation. Histological analysis confirmed a prolonged accumulation at the inflammation site, with a pronounced colocalization with the different components of the ECM (collagen III and fibronectin notably). Binding of the fusion protein appeared to be specific to the ECM but unspecific to particular components. Conclusion: Imaging of 64Cu-GPVI-Fc accumulation in the ECM matrix appears to be a promising candidate for monitoring chronic inflammation. By binding to exposed fibrous tissue (collagen, fibronectin, etc.) after extravasation, a new insight is provided into the fibrotic events resulting from a prolonged inflammatory state.
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Affiliation(s)
- Nicolas Beziere
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, Eberhard Karls University Tübingen, 72076 Tübingen, Germany
| | - Kerstin Fuchs
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, Eberhard Karls University Tübingen, 72076 Tübingen, Germany
| | - Andreas Maurer
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, Eberhard Karls University Tübingen, 72076 Tübingen, Germany
| | - Gerald Reischl
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, Eberhard Karls University Tübingen, 72076 Tübingen, Germany
| | - Jürgen Brück
- Department of Dermatology, University Medical Center, Eberhard Karls University Tübingen, 72076 Tübingen, Germany
| | - Kamran Ghoreschi
- Department of Dermatology, University Medical Center, Eberhard Karls University Tübingen, 72076 Tübingen, Germany
| | - Birgit Fehrenbacher
- Department of Dermatology, University Medical Center, Eberhard Karls University Tübingen, 72076 Tübingen, Germany
| | - Daniel Carvajal Berrio
- Department of Women's Health, Research Institute for Women's Health, Eberhard Karls University Tübingen, 72074 Tübingen, Germany
| | - Katja Schenke-Layland
- Department of Women's Health, Research Institute for Women's Health, Eberhard Karls University Tübingen, 72074 Tübingen, Germany
- The Natural and Medical Sciences Institute (NMI) at the University of Tübingen, Markwiesenstr. 55, 72770 Reutlingen, Germany
- Department of Medicine/ Cardiology, Cardiovascular Research Laboratories, David Geffen School of Medicine at UCLA, 675 Charles E. Young Drive South, MRL 3645, Los Angeles, CA, USA
| | - Ursula Kohlhofer
- Institute of Pathology, University Hospital Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany
| | - Leticia Quintanilla-Martinez
- Institute of Pathology, University Hospital Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany
| | - Meinrad Gawaz
- Department of Cardiology and Cardiovascular Medicine, University Hospital Tübingen, University of Tübingen, 72076 Tübingen, Germany
| | - Manfred Kneilling
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, Eberhard Karls University Tübingen, 72076 Tübingen, Germany
- Department of Dermatology, University Medical Center, Eberhard Karls University Tübingen, 72076 Tübingen, Germany
| | - Bernd Pichler
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, Eberhard Karls University Tübingen, 72076 Tübingen, Germany
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Yoon H, Shin HJ, Kim MJ, Han SJ, Koh H, Kim S, Lee MJ. Predicting gastroesophageal varices through spleen magnetic resonance elastography in pediatric liver fibrosis. World J Gastroenterol 2019; 25:367-377. [PMID: 30686904 PMCID: PMC6343098 DOI: 10.3748/wjg.v25.i3.367] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/12/2018] [Accepted: 12/21/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A recent retrospective study confirmed that hepatic stiffness and splenic stiffness measured with magnetic resonance elastography (MRE) are strongly associated with the presence of esophageal varices. In addition, strong correlations have been reported between splenic stiffness values measured with MRE and hepatic venous pressure gradients in animal models. However, most studies have been conducted on adult populations, and previous pediatric MRE studies have only demonstrated the feasibility of MRE in pediatric populations, while the actual clinical application of spleen MRE has been limited.
AIM To assess the utility of splenic stiffness measurements by MRE to predict gastroesophageal varices in children.
METHODS We retrospectively reviewed abdominal MRE images taken on a 3T system in pediatric patients. Patients who had undergone Kasai operations for biliary atresia were selected for the Kasai group, and patients with normal livers and spleens were selected for the control group. Two-dimensional spin-echo echo-planar MRE acquisition centered on the liver, with a pneumatic driver at 60 Hz and a low amplitude, was performed to obtain hepatic and splenic stiffness values. Laboratory results for aspartate aminotransferase to platelet ratio index (APRI) were evaluated within six months of MRE, and the normalized spleen size ratio was determined with the upper normal size limit. All Kasai group patients underwent gastroesophageal endoscopy during routine follow-up. The Mann-Whitney U test, Kendall's tau b correlation and diagnostic performance analysis using the area under the curve (AUC) were performed for statistical analysis.
RESULTS The median spleen MRE value was 5.5 kPa in the control group (n = 9, age 9-18 years, range 4.7-6.4 kPa) and 8.6 kPa in the Kasai group (n = 22, age 4-18 years, range 5.0-17.8 kPa). In the Kasai group, the APRI, spleen size ratio and spleen MRE values were higher in patients with portal hypertension (n = 11) than in patients without (n = 11) (all P < 0.001) and in patients with gastroesophageal varices (n = 6) than in patients without (n = 16) (all P < 0.05), even though their liver MRE values were not different. The APRI (τ = 0.477, P = 0.007), spleen size ratio (τ = 0.401, P = 0.024) and spleen MRE values (τ = 0.426, P = 0.016) also correlated with varices grades. The AUC in predicting gastroesophageal varices was 0.844 at a cut-off of 0.65 (100% sensitivity and 75% specificity) for the APRI, and 0.844 at a cut-off of 9.9 kPa (83.3% sensitivity and 81.3% specificity) for spleen MRE values.
CONCLUSION At a cut-off of 9.9 kPa, spleen MRE values predicted gastroesophageal varices as well as the APRI and spleen size ratio in biliary atresia patients after the Kasai operation. However, liver MRE values were not useful for this purpose.
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Affiliation(s)
- Haesung Yoon
- Department of Radiology, Severance Hospital, Severance Pediatric Liver Disease Research Group, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 03722, South Korea
| | - Hyun Joo Shin
- Department of Radiology, Severance Hospital, Severance Pediatric Liver Disease Research Group, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 03722, South Korea
| | - Myung-Joon Kim
- Department of Radiology, Severance Hospital, Severance Pediatric Liver Disease Research Group, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 03722, South Korea
| | - Seok Joo Han
- Department of Surgery, Severance Hospital, Severance Pediatric Liver Disease Research Group, Yonsei University College of Medicine, Seoul 03722, South Korea
| | - Hong Koh
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Severance Children’s Hospital, Severance Pediatric Liver Disease Research Group, Yonsei University College of Medicine, Seoul 03722, South Korea
| | - Seung Kim
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Severance Children’s Hospital, Severance Pediatric Liver Disease Research Group, Yonsei University College of Medicine, Seoul 03722, South Korea
| | - Mi-Jung Lee
- Department of Radiology, Severance Hospital, Severance Pediatric Liver Disease Research Group, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 03722, South Korea
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13
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Garteiser P, Doblas S, Van Beers BE. Magnetic resonance elastography of liver and spleen: Methods and applications. NMR IN BIOMEDICINE 2018; 31:e3891. [PMID: 29369503 DOI: 10.1002/nbm.3891] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/16/2017] [Accepted: 12/04/2017] [Indexed: 05/06/2023]
Abstract
The viscoelastic properties of the liver and spleen can be assessed with magnetic resonance elastography (MRE). Several actuators, MRI acquisition sequences and reconstruction algorithms have been proposed for this purpose. Reproducible results are obtained, especially when the examination is performed in standard conditions with the patient fasting. Accurate staging of liver fibrosis can be obtained by measuring liver stiffness or elasticity with MRE. Moreover, emerging evidence shows that assessing the tissue viscous parameters with MRE is useful for characterizing liver inflammation, non-alcoholic steatohepatitis, hepatic congestion, portal hypertension, and hepatic tumors. Further advances such as multifrequency acquisitions and compression-sensitive MRE may provide novel quantitative markers of hepatic and splenic mechanical properties that may improve the diagnosis of hepatic and splenic diseases.
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Affiliation(s)
- Philippe Garteiser
- Laboratory of Imaging Biomarkers, Center of Research on Inflammation, UMR 1149 INSERM-University Paris Diderot, Paris, France
| | - Sabrina Doblas
- Laboratory of Imaging Biomarkers, Center of Research on Inflammation, UMR 1149 INSERM-University Paris Diderot, Paris, France
| | - Bernard E Van Beers
- Laboratory of Imaging Biomarkers, Center of Research on Inflammation, UMR 1149 INSERM-University Paris Diderot, Paris, France
- Department of Radiology, Beaujon University Hospital Paris Nord, Clichy, France
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Kim SR, Lerman LO. Diagnostic imaging in the management of patients with metabolic syndrome. Transl Res 2018; 194:1-18. [PMID: 29175480 PMCID: PMC5839955 DOI: 10.1016/j.trsl.2017.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/18/2017] [Accepted: 10/26/2017] [Indexed: 02/07/2023]
Abstract
Metabolic syndrome (MetS) is the constellation of metabolic risk factors that might foster development of type 2 diabetes and cardiovascular disease. Abdominal obesity and insulin resistance play a prominent role among all metabolic traits of MetS. Because intervention including weight loss can reduce these morbidity and mortality in MetS, early detection of the severity and complications of MetS could be useful. Recent advances in imaging modalities have provided significant insight into the development and progression of abdominal obesity and insulin resistance, as well as target organ injuries. The purpose of this review is to summarize advances in diagnostic imaging modalities in MetS that can be applied for evaluating each components and target organs. This may help in early detection, monitoring target organ injury, and in turn developing novel therapeutic target to alleviate and avert them.
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Affiliation(s)
- Seo Rin Kim
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minn
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minn.
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15
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Welsh JA, Scorletti E, Clough GF, Englyst NA, Byrne CD. Leukocyte extracellular vesicle concentration is inversely associated with liver fibrosis severity in NAFLD. J Leukoc Biol 2018; 104:631-639. [DOI: 10.1002/jlb.5a1217-501r] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/04/2018] [Accepted: 03/08/2018] [Indexed: 12/21/2022] Open
Affiliation(s)
- Joshua A. Welsh
- Human Development and Health Academic Unit; Faculty of Medicine; University of Southampton; Southampton United Kingdom
| | - Eleonora Scorletti
- Human Development and Health Academic Unit; Faculty of Medicine; University of Southampton; Southampton United Kingdom
| | - Geraldine F. Clough
- Human Development and Health Academic Unit; Faculty of Medicine; University of Southampton; Southampton United Kingdom
| | - Nicola A. Englyst
- Human Development and Health Academic Unit; Faculty of Medicine; University of Southampton; Southampton United Kingdom
| | - Christopher D. Byrne
- Human Development and Health Academic Unit; Faculty of Medicine; University of Southampton; Southampton United Kingdom
- National Institute for Health Research, Southampton Biomedical Research Centre; University Hospital Southampton NHS Foundation Trust; University of Southampton; Southampton United Kingdom
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16
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Trout AT, Sheridan RM, Serai SD, Xanthakos SA, Su W, Zhang B, Wallihan DB. Diagnostic Performance of MR Elastography for Liver Fibrosis in Children and Young Adults with a Spectrum of Liver Diseases. Radiology 2018; 287:824-832. [PMID: 29470938 DOI: 10.1148/radiol.2018172099] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose To assess the diagnostic performance of magnetic resonance (MR) elastography-derived liver stiffness to detect liver fibrosis in a pediatric and young adult population with a spectrum of liver diseases. Materials and Methods This retrospective study included patients younger than 21 years of age who underwent MR elastography and liver biopsy within 3 months of one another between January 2012 and September 2016 for indications other than liver transplantation or Fontan palliation of congenital heart disease. MR elastography examinations were reprocessed by a single observer, blinded to pathologic findings. Pathology specimens were reviewed by a single pathologist who scored steatosis (lipid in ≥ 5% of hepatocytes) and staged fibrosis. Receiver operating characteristic (ROC) curves were used to assess diagnostic performance. Results A total of 86 patients, 49 (57%) male with a median age of 14.2 years (range, 0.3-20.6 years), were included. Fifty-one patients (59.3%) had Ludwig stage 2 or higher fibrosis; 44 patients (51.2%) had hepatic steatosis. The area under the ROC curve for Ludwig stage 0-1 versus stage 2 or higher fibrosis was 0.70 (95% confidence interval [CI]: 0.59, 0.81) for the whole population and was significantly lower for patients with steatosis versus those without (0.53 [95% CI: 0.35, 0.71] vs 0.82 [95% CI: 0.67, 0.96], P = .014). Optimal stiffness cut-offs for the entire population were 2.27 kPa with 68.6% sensitivity (95% CI: 57.2%, 80.1%) and 74.3% specificity (95% CI: 63.5%, 85.1%) or 1.67 kPa with 35.3% sensitivity (95% CI: 23.5%, 47.1%) and 91.4% specificity (95% CI: 84.5%, 98.3%). Conclusion In children and young adults, MR elastography performs significantly better for distinguishing stage 0-1 versus stage 2 or higher fibrosis in patients without steatosis than in those with steatosis. This suggests a confounding effect of steatosis or inflammation in the population with nonalcoholic fatty liver disease. © RSNA, 2018.
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Affiliation(s)
- Andrew T Trout
- From the Department of Radiology (A.T.T., S.D.S.), Division of Pathology and Laboratory Medicine (R.M.S.), Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), and Division of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45299; Department of Mathematical Sciences, University of Cincinnati, Cincinnati, Ohio (W.S.); and Levine Children's Hospital, Charlotte, NC (D.B.W.)
| | - Rachel M Sheridan
- From the Department of Radiology (A.T.T., S.D.S.), Division of Pathology and Laboratory Medicine (R.M.S.), Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), and Division of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45299; Department of Mathematical Sciences, University of Cincinnati, Cincinnati, Ohio (W.S.); and Levine Children's Hospital, Charlotte, NC (D.B.W.)
| | - Suraj D Serai
- From the Department of Radiology (A.T.T., S.D.S.), Division of Pathology and Laboratory Medicine (R.M.S.), Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), and Division of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45299; Department of Mathematical Sciences, University of Cincinnati, Cincinnati, Ohio (W.S.); and Levine Children's Hospital, Charlotte, NC (D.B.W.)
| | - Stavra A Xanthakos
- From the Department of Radiology (A.T.T., S.D.S.), Division of Pathology and Laboratory Medicine (R.M.S.), Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), and Division of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45299; Department of Mathematical Sciences, University of Cincinnati, Cincinnati, Ohio (W.S.); and Levine Children's Hospital, Charlotte, NC (D.B.W.)
| | - Weizhe Su
- From the Department of Radiology (A.T.T., S.D.S.), Division of Pathology and Laboratory Medicine (R.M.S.), Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), and Division of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45299; Department of Mathematical Sciences, University of Cincinnati, Cincinnati, Ohio (W.S.); and Levine Children's Hospital, Charlotte, NC (D.B.W.)
| | - Bin Zhang
- From the Department of Radiology (A.T.T., S.D.S.), Division of Pathology and Laboratory Medicine (R.M.S.), Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), and Division of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45299; Department of Mathematical Sciences, University of Cincinnati, Cincinnati, Ohio (W.S.); and Levine Children's Hospital, Charlotte, NC (D.B.W.)
| | - Daniel B Wallihan
- From the Department of Radiology (A.T.T., S.D.S.), Division of Pathology and Laboratory Medicine (R.M.S.), Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), and Division of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45299; Department of Mathematical Sciences, University of Cincinnati, Cincinnati, Ohio (W.S.); and Levine Children's Hospital, Charlotte, NC (D.B.W.)
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Abstract
Liver fibrosis is an important pathological precondition for hepatocellular carcinoma. The degree of hepatic fibrosis is positively correlated with liver cancer. Liver fibrosis is a series of pathological and physiological process related to liver cell necrosis and degeneration after chronic liver injury, which finally leads to extracellular matrix and collagen deposition. The early detection and precise staging of fibrosis and cirrhosis are very important for early diagnosis and timely initiation of appropriate therapeutic regimens. The risk of severe liver fibrosis finally progressing to liver carcinoma is >50%. It is known that biopsy is the gold standard for the diagnosis and staging of liver fibrosis. However, this method has some limitations, such as the potential for pain, sampling variability, and low patient acceptance. Furthermore, the necessity of obtaining a tissue diagnosis of liver fibrosis still remains controversial. An increasing number of reliable non-invasive approaches are now available that are widely applied in clinical practice, mostly in cases of viral hepatitis, resulting in a significantly decreased need for liver biopsy. In fact, the non-invasive detection and evaluation of liver cirrhosis now has good accuracy due to current serum markers, ultrasound imaging, and magnetic resonance imaging quantification techniques. A prominent advantage of the non-invasive detection and assessment of liver fibrosis is that liver fibrosis can be monitored repeatedly and easily in the same patient. Serum biomarkers have the advantages of high applicability (>95%) and good reproducibility. However, their results can be influenced by different patient conditions because none of these markers are liver-specific. The most promising techniques appear to be transient elastography and magnetic resonance elastography because they provide reliable results for the detection of fibrosis in the advanced stages, and future developments promise to increase the reliability and accuracy of the staging of hepatic fibrosis. This article aims to describe the recent progress in the development of non-invasive assessment methods for the staging of liver fibrosis, with a special emphasize on computer-aided quantitative and deep learning methods.
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Affiliation(s)
- Chengxi Li
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Rentao Li
- Department of Hepatobiliary Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Wei Zhang
- Department of Hepatobiliary Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
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18
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Chou CT, Chen RC, Wu WP, Lin PY, Chen YL. Prospective Comparison of the Diagnostic Performance of Magnetic Resonance Elastography with Acoustic Radiation Force Impulse Elastography for Pre-operative Staging of Hepatic Fibrosis in Patients with Hepatocellular Carcinoma. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2783-2790. [PMID: 28965721 DOI: 10.1016/j.ultrasmedbio.2017.08.1879] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 08/14/2017] [Accepted: 08/20/2017] [Indexed: 06/07/2023]
Abstract
The purpose of this study was to compare the diagnostic accuracy of magnetic resonance (MR) elastography with that of acoustic radiation force impulse (ARFI) elastography for pre-operative staging of hepatic fibrosis in patients with hepatocellular carcinoma. We prospectively enrolled 77 patients who were scheduled to undergo hepatectomy for hepatocellular carcinoma. Pre-operative MRE and ARFI elastography examinations were performed on the same day, and liver stiffness/velocity values were determined. Fibrosis stage and necro-inflammatory activity of resected specimens were determined histopathologically using the METAVIR scoring system. Correlations between MRE and ARFI elastography findings and histologic findings were determined by receiver operating characteristic (ROC) analysis. Correlation of MRE was excellent and correlation of ARFI elastography was good with fibrosis stage. MRE had better diagnostic performance than ARFI elastography in estimating substantial fibrosis (F2), severe fibrosis (F3) and cirrhosis (F4). The optimal cutoff value and the area under the ROC curve (AUROC) were determined using ROC curve analysis. The highest Youden index was used as a criterion for selecting the optimal cutoff value. ROC analysis revealed that MRE discriminated advanced stages of fibrosis (F ≥ 2) well in patients with hepatocellular carcinoma at a cutoff value of 3.0 kPa with an AUROC value of 0.93, and ARFI elastography did so at a cutoff value of 1.77 m/s with an AUROC value of 0.81 for predicting advanced stages of fibrosis (F ≥ 2). In conclusion, MRE is a more accurate imaging modality than ARFI elastography in estimating advanced stages of fibrosis and cirrhosis.
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Affiliation(s)
- Chen-Te Chou
- Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan; Department of Biomedical Imaging and Radiological Science, National Yang-Ming Medical University, Taipei, Taiwan; School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ran-Chou Chen
- Department of Biomedical Imaging and Radiological Science, National Yang-Ming Medical University, Taipei, Taiwan
| | - Wen-Pei Wu
- Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan; Department of Biomedical Imaging and Radiological Science, National Yang-Ming Medical University, Taipei, Taiwan
| | - Ping-Yi Lin
- Transplant Medicine and Surgery Research Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Yao-Li Chen
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Transplant Medicine and Surgery Research Center, Changhua Christian Hospital, Changhua, Taiwan.
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19
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Mitsuka Y, Midorikawa Y, Abe H, Matsumoto N, Moriyama M, Haradome H, Sugitani M, Tsuji S, Takayama T. A prediction model for the grade of liver fibrosis using magnetic resonance elastography. BMC Gastroenterol 2017; 17:133. [PMID: 29179678 PMCID: PMC5704624 DOI: 10.1186/s12876-017-0700-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 11/20/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Liver stiffness measurement (LSM) has recently become available for assessment of liver fibrosis. We aimed to develop a prediction model for liver fibrosis using clinical variables, including LSM. METHODS We performed a prospective study to compare liver fibrosis grade with fibrosis score. LSM was measured using magnetic resonance elastography in 184 patients that underwent liver resection, and liver fibrosis grade was diagnosed histologically after surgery. Using the prediction model established in the training group, we validated the classification accuracy in the independent test group. RESULTS First, we determined a cut-off value for stratifying fibrosis grade using LSM in 122 patients in the training group, and correctly diagnosed fibrosis grades of 62 patients in the test group with a total accuracy of 69.3%. Next, on least absolute shrinkage and selection operator analysis in the training group, LSM (r = 0.687, P < 0.001), indocyanine green clearance rate at 15 min (ICGR15) (r = 0.527, P < 0.001), platelet count (r = -0.537, P < 0.001) were selected as variables for the liver fibrosis prediction model. This prediction model applied to the test group correctly diagnosed 32 of 36 (88.8%) Grade I (F0 and F1) patients, 13 of 18 (72.2%) Grade II (F2 and F3) patients, and 7 of 8 (87.5%) Grade III (F4) patients in the test group, with a total accuracy of 83.8%. CONCLUSIONS The prediction model based on LSM, ICGR15, and platelet count can accurately and reproducibly predict liver fibrosis grade.
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Affiliation(s)
- Yusuke Mitsuka
- Department of Digestive Surgery, Nihon University Faculty of Medicine, 30-1 Oyaguchi Kami-machi, Tokyo, Itabashi-ku, 173-8610, Japan
| | - Yutaka Midorikawa
- Department of Digestive Surgery, Nihon University Faculty of Medicine, 30-1 Oyaguchi Kami-machi, Tokyo, Itabashi-ku, 173-8610, Japan.
| | - Hayato Abe
- Department of Digestive Surgery, Nihon University Faculty of Medicine, 30-1 Oyaguchi Kami-machi, Tokyo, Itabashi-ku, 173-8610, Japan
| | - Naoki Matsumoto
- Department of Gastroenterology and Hepatology, Nihon University Faculty of Medicine, 30-1 Oyaguchi Kami-machi, Tokyo, Itabashi-ku, 173-8610, Japan
| | - Mitsuhiko Moriyama
- Department of Gastroenterology and Hepatology, Nihon University Faculty of Medicine, 30-1 Oyaguchi Kami-machi, Tokyo, Itabashi-ku, 173-8610, Japan
| | - Hiroki Haradome
- Department of Radiology, Nihon University Faculty of Medicine, 30-1 Oyaguchi Kami-machi, Tokyo, Itabashi-ku, 173-8610, Japan
| | - Masahiko Sugitani
- Department of Pathology, Nihon University Faculty of Medicine, 30-1 Oyaguchi Kami-machi, Tokyo, Itabashi-ku, 173-8610, Japan
| | - Shingo Tsuji
- Research Center of Advanced Science and Technology, Genome Science Division, University of Tokyo, 4-6-1 Komaba, Tokyo, Meguro-ku, 153-8904, Japan
| | - Tadatoshi Takayama
- Department of Digestive Surgery, Nihon University Faculty of Medicine, 30-1 Oyaguchi Kami-machi, Tokyo, Itabashi-ku, 173-8610, Japan
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20
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Comparison of gradient-recalled echo and spin-echo echo-planar imaging MR elastography in staging liver fibrosis: a meta-analysis. Eur Radiol 2017; 28:1709-1718. [PMID: 29164384 DOI: 10.1007/s00330-017-5149-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/08/2017] [Accepted: 10/18/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To compare the diagnostic performance of gradient-recalled echo-based magnetic resonance elastography (GRE-MRE) and spin-echo echo-planar imaging-based MRE (SE-EPI-MRE) in liver fibrosis staging. METHODS A systematic literature search was performed to identify studies involving the performance of MRE for the diagnosis of liver fibrosis. Pooled sensitivity, specificity, positive and negative likelihood ratios, the diagnostic odds ratio, and a summary receiver operating characteristic (ROC) curve were estimated by using a bivariate random effects model. Subgroup analyses were performed between different study characteristics. RESULTS Twenty-six studies with a total of 3,200 patients were included in the meta-analysis. Pooled sensitivity and specificity of GRE-MRE and SE-EPI-MRE did not differ significantly. The area under the summary ROC curve for stage diagnosis of any (F ≥ 1), significant (F ≥ 2), advanced (F ≥ 3), and cirrhosis (F = 4) on GRE-MRE and SE-EPI-MRE were 0.93 versus 0.94, 0.95 versus 0.94, 0.94 versus 0.95, and 0.92 versus 0.93, respectively. Substantial heterogeneity was detected for both sequences. CONCLUSION Both GRE and SE-EPI-MRE show high sensitivity and specificity for detection of each stage of liver fibrosis, without significant differences. Magnetic resonance elastography (MRE) may be useful for noninvasive evaluation of liver fibrosis in chronic liver disease. KEY POINTS • Pooled sensitivity and specificity of GRE-MRE and SE-EPI-MRE did not differ significantly. • GRE-MRE and SE-EPI-MRE were highly accurate for detecting all stages of fibrosis. • Due to better agreement and repeatability, GRE-MRE should be used first. • In case of failure on GRE-MRE, SE-EPI-MRE should be used.
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21
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Costa-Silva L, Ferolla SM, Lima AS, Vidigal PVT, Ferrari TCDA. MR elastography is effective for the non-invasive evaluation of fibrosis and necroinflammatory activity in patients with nonalcoholic fatty liver disease. Eur J Radiol 2017; 98:82-89. [PMID: 29279175 DOI: 10.1016/j.ejrad.2017.11.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To evaluate the performance of magnetic resonance elastography (MRE) in diagnosing and staging hepatic fibrosis in patients with histologically confirmed nonalcoholic fatty liver disease (NAFLD) and in distinguishing simple steatosis from nonalcoholic steatohepatitis (NASH). METHODS Ninety subjects (49 NAFLD patients and 41 healthy volunteers) were prospectively enrolled. Liver stiffness measured by MRE was correlated with the grade of fibrosis and/or inflammation determined by liver biopsy. Correlations, ROC (receiver operator characteristic) curves and diagnostic performance were evaluated. The study was approved by the local ethics committee. RESULTS The area under the ROC curve (AUROC) of MRE in discriminating healthy from NAFLD individuals was 0.964 (P<0.0001), and that for distinguishing advanced (F3-F4) from absent/mild fibrosis (F0-F2) was 0.928 (P<0.0001). The use of a threshold >4.39 kPa resulted in a sensitivity of 90.9% and a specificity of 97.3% for diagnosing advanced fibrosis. For discriminating NASH from simple steatosis, the AUROC was 0.783 (P<0.0001), and the threshold, 3.22 kPa. CONCLUSIONS MRE is an effective, non-invasive method for detecting/staging hepatic fibrosis in NAFLD. This method has good performance in discriminating normal from NAFLD subjects and between the extreme grades of fibrosis. NAFLD patients with inflammation and without fibrosis have higher liver stiffness than those with simple steatosis.
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Affiliation(s)
- Luciana Costa-Silva
- Departmento de Anatomia e Imagem, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Av. Professor Alfredo Balena 190, 30130-100, Belo Horizonte, Minas Gerais, Brazil; Instituto Hermes Pardini, Rua dos Aimorés 66, 30140-070, Belo Horizonte, Minas Gerais, Brazil.
| | - Silvia Marinho Ferolla
- Instituto Alfa de Gastroenterologia, Hospital das Clínicas, UFMG, Av. Professor Alfredo Balena, 110, 30130-100, Belo Horizonte, Minas Gerais, Brazil.
| | - Agnaldo Soares Lima
- Instituto Alfa de Gastroenterologia, Hospital das Clínicas, UFMG, Av. Professor Alfredo Balena, 110, 30130-100, Belo Horizonte, Minas Gerais, Brazil; Departmento de Cirurgia, Faculdade de Medicina, UFMG, Av. Professor Alfredo Balena, 190, 30130-100, Belo Horizonte, Minas Gerais, Brazil.
| | - Paula Vieira Teixeira Vidigal
- Departmento de Anatomia Patológica e Medicina Legal, Faculdade de Medicina, UFMG, Av. Professor Alfredo Balena, 190, 30130-100, Belo Horizonte, Minas Gerais, Brazil.
| | - Teresa Cristina de Abreu Ferrari
- Instituto Alfa de Gastroenterologia, Hospital das Clínicas, UFMG, Av. Professor Alfredo Balena, 110, 30130-100, Belo Horizonte, Minas Gerais, Brazil; Departmento de Clínica Médica, Faculdade de Medicina, UFMG, Av. Professor Alfredo Balena, 190, 30130-100, Belo Horizonte, Minas Gerais, Brazil.
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Morisaka H, Motosugi U, Ichikawa S, Nakazawa T, Kondo T, Funayama S, Matsuda M, Ichikawa T, Onishi H. Magnetic resonance elastography is as accurate as liver biopsy for liver fibrosis staging. J Magn Reson Imaging 2017; 47:1268-1275. [PMID: 29030995 DOI: 10.1002/jmri.25868] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 09/19/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Liver MR elastography (MRE) is available for the noninvasive assessment of liver fibrosis; however, no previous studies have compared the diagnostic ability of MRE with that of liver biopsy. PURPOSE To compare the diagnostic accuracy of liver fibrosis staging between MRE-based methods and liver biopsy using the resected liver specimens as the reference standard. STUDY TYPE A retrospective study at a single institution. POPULATION In all, 200 patients who underwent preoperative MRE and subsequent surgical liver resection were included in this study. Data from 80 patients were used to estimate cutoff and distributions of liver stiffness values measured by MRE for each liver fibrosis stage (F0-F4, METAVIR system). In the remaining 120 patients, liver biopsy specimens were obtained from the resected liver tissues using a standard biopsy needle. FIELD STRENGTH/SEQUENCE 2D liver MRE with gradient-echo based sequence on a 1.5 or 3T scanner was used. ASSESSMENT Two radiologists independently measured the liver stiffness value on MRE and two types of MRE-based methods (threshold and Bayesian prediction method) were applied. Two pathologists evaluated all biopsy samples independently to stage liver fibrosis. Surgically resected whole tissue specimens were used as the reference standard. STATISTICAL TESTS The accuracy for liver fibrosis staging was compared between liver biopsy and MRE-based methods with a modified McNemar's test. RESULTS Accurate fibrosis staging was achieved in 53.3% (64/120) and 59.1% (71/120) of patients using MRE with threshold and Bayesian methods, respectively, and in 51.6% (62/120) with liver biopsy. Accuracies of MRE-based methods for diagnoses of ≥F2 (90-91% [108-9/120]), ≥F3 (79-81% [95-97/120]), and F4 (82-85% [98-102/120]) were statistically equivalent to those of liver biopsy (≥F2, 79% [95/120], P ≤ 0.01; ≥F3, 88% [105/120], P ≤ 0.006; and F4, 82% [99/120], P ≤ 0.017). DATA CONCLUSION MRE can be an alternative to liver biopsy for fibrosis staging. LEVEL OF EVIDENCE 3. Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1268-1275.
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Affiliation(s)
- Hiroyuki Morisaka
- Department of Radiology, University of Yamanashi, Yamanashi, Japan.,Diagnostic Radiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Utaroh Motosugi
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | | | - Tadao Nakazawa
- Department of Pathology, University of Yamanashi, Yamanashi, Japan
| | - Tetsuo Kondo
- Department of Pathology, University of Yamanashi, Yamanashi, Japan
| | - Satoshi Funayama
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Masanori Matsuda
- Department of Gastrointestinal Surgery, University of Yamanashi, Yamanashi, Japan
| | - Tomoaki Ichikawa
- Diagnostic Radiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
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23
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Abe H, Midorikawa Y, Mitsuka Y, Aramaki O, Higaki T, Matsumoto N, Moriyama M, Haradome H, Abe O, Sugitani M, Tsuji S, Takayama T. Predicting postoperative outcomes of liver resection by magnetic resonance elastography. Surgery 2017; 162:248-255. [PMID: 28411865 DOI: 10.1016/j.surg.2017.02.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/15/2017] [Accepted: 02/15/2017] [Indexed: 02/09/2023]
Abstract
BACKGROUND Cirrhosis is associated with blood loss during liver resection and postoperative complications. The liver stiffness measurement has recently become available for assessment of liver fibrosis. METHODS This prospective study was performed to predict postoperative outcomes of liver resection. The liver stiffness measurement was measured prospectively using magnetic resonance elastography for patients who had undergone liver resection for malignancy. We investigated whether the liver stiffness measurement by magnetic resonance elastography is correlated with liver fibrosis and postoperative outcomes. RESULTS The median liver stiffness measurement by magnetic resonance elastography in 175 patients was 3.4 (range: 1.5-11.3) kPa, and the pathologic grade of liver fibrosis was significantly correlated with the liver stiffness measurement (r = 0.68, P < .001). The median blood loss during transection per unit area was 4.1 mL/cm2 (range: 0.1-37.0 mL/cm2), and the frequency of major complications was 16.0%. The liver stiffness measurement was the only independent prognostic factor for both blood loss (regression coefficient: 1.14, 95% confidence interval: 0.45-1.83, P = .001) and major complications (odds ratio: 2.14, 95% confidence interval: 1.63-2.93, P < .001). Receiver operating characteristic curve analysis indicated a significant correlation between the liver stiffness measurement and major complications with calculated area under the curve of 0.81 (P < .001), and the sensitivity and specificity for prediction of major complications (cutoff value: 5.3 kPa) were 64.3% and 87.8%, respectively. On the other hand, the amount of blood loss was significantly correlated with the frequency of major complications (P = .003). CONCLUSION The liver stiffness measurement by magnetic resonance elastography could be used as a predictive marker for the risk of major complications due to blood loss during liver resection.
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Affiliation(s)
- Hayato Abe
- Department of Digestive Surgery, Nihon University Faculty of Medicine, Tokyo, Japan
| | - Yutaka Midorikawa
- Department of Digestive Surgery, Nihon University Faculty of Medicine, Tokyo, Japan.
| | - Yusuke Mitsuka
- Department of Digestive Surgery, Nihon University Faculty of Medicine, Tokyo, Japan
| | - Osamu Aramaki
- Department of Digestive Surgery, Nihon University Faculty of Medicine, Tokyo, Japan
| | - Tokio Higaki
- Department of Digestive Surgery, Nihon University Faculty of Medicine, Tokyo, Japan
| | - Naoki Matsumoto
- Department of Gastroenterology and Hepatology, Nihon University Faculty of Medicine, Tokyo, Japan
| | - Mitsuhiko Moriyama
- Department of Gastroenterology and Hepatology, Nihon University Faculty of Medicine, Tokyo, Japan
| | - Hiroki Haradome
- Department of Radiology, Nihon University Faculty of Medicine, Tokyo, Japan
| | - Osamu Abe
- Department of Radiology, Nihon University Faculty of Medicine, Tokyo, Japan; Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masahiko Sugitani
- Department of Pathology, Nihon University Faculty of Medicine, Tokyo, Japan
| | - Shingo Tsuji
- Research Center of Advanced Science and Technology, Genome Science Divisions, University of Tokyo, Tokyo, Japan
| | - Tadatoshi Takayama
- Department of Digestive Surgery, Nihon University Faculty of Medicine, Tokyo, Japan
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24
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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: 2.3] [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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25
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Trout AT, Serai S, Mahley AD, Wang H, Zhang Y, Zhang B, Dillman JR. Liver Stiffness Measurements with MR Elastography: Agreement and Repeatability across Imaging Systems, Field Strengths, and Pulse Sequences. Radiology 2016; 281:793-804. [PMID: 27285061 DOI: 10.1148/radiol.2016160209] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose To prospectively assess agreement and repeatability of magnetic resonance (MR) elastography liver stiffness measurements across imager manufacturers, field strengths, and pulse sequences. Materials and Methods This prospective cross-sectional study was approved by the institutional review board; informed consent was obtained from all subjects. On the basis of an a priori power calculation, 24 volunteer adult subjects underwent MR elastography with four MR imaging systems (two vendors) and multiple pulse sequences (two-dimensional [2D] gradient-echo [GRE] imaging, 2D spin-echo [SE] echo-planar imaging, and three-dimensional [3D] SE echo-planar imaging). Each sequence was performed twice in each patient with each imaging system. Intraclass correlation coefficients (ICCs) were used to assess agreement and repeatability. P < .05 was considered indicative of a statistically significant difference. Results Pairwise ICCs were 0.67-0.82 and 0.62-0.83 for agreement between pulse sequences across manufacturers (n = 4) and field strengths (n = 5), respectively. ICCs were 0.45-0.90 for pairwise agreement between sequences while fixing manufacturer and field strength (n = 8). Test-retest repeatability across the various manufacturer, field strength, and pulse sequence combinations (n = 10) was excellent (ICCs, 0.77-0.94). The overall ICC for all manufacturer, field strength, and sequence combinations (n = 10) was 0.68 (95% confidence interval [CI]: 0.55, 0.82). ICC according to field strength was 0.78 (95% CI: 0.67, 0.88) at 1.5 T (n = 5) and 0.64 (95% CI: 0.49, 0.78) at 3.0 T (n = 5). ICCs according to vendor were 0.83 (95% CI: 0.73, 0.91) (n = 4) and 0.65 (95% CI: 0.51, 0.79) (n = 6). Average patient level variance was 0.042 kPa, with a coefficient of variation of 10.7%. Conclusion MR elastography is a reliable method for assessing liver stiffness, with small amounts of variability between imager manufacturers, field strengths, and pulse sequences. © RSNA, 2016.
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Affiliation(s)
- Andrew T Trout
- From the Department of Radiology (A.T.T., S.S., A.D.M., J.R.D.) and Department of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026; Philips Healthcare, Cincinnati, Ohio (H.W.); and Department of Mathematical Science, University of Cincinnati, Cincinnati, Ohio (Y.Z.)
| | - Suraj Serai
- From the Department of Radiology (A.T.T., S.S., A.D.M., J.R.D.) and Department of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026; Philips Healthcare, Cincinnati, Ohio (H.W.); and Department of Mathematical Science, University of Cincinnati, Cincinnati, Ohio (Y.Z.)
| | - Alana D Mahley
- From the Department of Radiology (A.T.T., S.S., A.D.M., J.R.D.) and Department of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026; Philips Healthcare, Cincinnati, Ohio (H.W.); and Department of Mathematical Science, University of Cincinnati, Cincinnati, Ohio (Y.Z.)
| | - Hui Wang
- From the Department of Radiology (A.T.T., S.S., A.D.M., J.R.D.) and Department of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026; Philips Healthcare, Cincinnati, Ohio (H.W.); and Department of Mathematical Science, University of Cincinnati, Cincinnati, Ohio (Y.Z.)
| | - Yue Zhang
- From the Department of Radiology (A.T.T., S.S., A.D.M., J.R.D.) and Department of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026; Philips Healthcare, Cincinnati, Ohio (H.W.); and Department of Mathematical Science, University of Cincinnati, Cincinnati, Ohio (Y.Z.)
| | - Bin Zhang
- From the Department of Radiology (A.T.T., S.S., A.D.M., J.R.D.) and Department of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026; Philips Healthcare, Cincinnati, Ohio (H.W.); and Department of Mathematical Science, University of Cincinnati, Cincinnati, Ohio (Y.Z.)
| | - Jonathan R Dillman
- From the Department of Radiology (A.T.T., S.S., A.D.M., J.R.D.) and Department of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229-3026; Philips Healthcare, Cincinnati, Ohio (H.W.); and Department of Mathematical Science, University of Cincinnati, Cincinnati, Ohio (Y.Z.)
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26
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Zhang G, Hu Y, Lu LG. Opportunity and challenge for diagnosis and treatment of hepatic fibrosis. Shijie Huaren Xiaohua Zazhi 2015; 23:5743-5749. [DOI: 10.11569/wcjd.v23.i36.5743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatic fibrosis is a wound-healing response to all kinds of chronic liver injuries, which is characterized by extracellular matrix remodeling. Hepatic fibrosis ultimately leads to cirrhosis and even hepatic cell carcinoma. Thus, diagnosis and treatment of hepatic fibrosis are important for the management of chronic liver diseases. Recently, the study of hepatic fibrogenesis has witnessed tremendous progress, with many new diagnostic and therapeutic options emerging. This article mainly discusses the opportunity and challenge for diagnosis and treatment of hepatic fibrosis.
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27
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Fenstad ER, Dzyubak B, Oh JK, Williamson EE, F Glockner J, Young PM, Anavekar NS, Leise MD, Ehman RL, Araoz PA, Venkatesh SK. Evaluation of liver stiffness with magnetic resonance elastography in patients with constrictive pericarditis: Preliminary findings. J Magn Reson Imaging 2015; 44:81-8. [PMID: 26691749 DOI: 10.1002/jmri.25126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 12/01/2015] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To evaluate with magnetic resonance elastography (MRE) whether patients with constrictive pericarditis (CP) have increased hepatic stiffness. CP results in reduced pericardial compliance, ventricular interdependence, and right heart failure. Patients with untreated CP may develop liver fibrosis and ultimately cirrhosis due to chronic venous congestion. Chronic venous congestion ± fibrosis may lead to increased liver stiffness. MATERIALS AND METHODS Prospectively, patients with suspected CP underwent 2D transthoracic echocardiography, cardiac MRI, and liver MRE. An automated method was used to draw regions of interest (ROIs) on the stiffness maps to calculate the mean liver stiffness in kilopascals (kPa). A t-test with α = 0.05 was performed between stiffness values of patients with positive and negative CP findings based on previously published echocardiography criteria. RESULTS Nineteen patients met inclusion criteria with a mean ± standard deviation (SD) age of 51 ± 16 years. Nine patients (47%) had CP. Mean liver stiffness trended higher in patients with CP compared to those without CP (4.04 kPa vs. 2.46; P = 0.045). Liver stiffness correlated with MRI septal bounce (P = 0.04), inferior vena cava size (P = 0.003), echo abnormal septal motion (P = 0.04), and echo mitral inflow variation >25% (P = 0.02). Only MRI septal bounce predicted CP by echocardiography (P < 0.001). CONCLUSION CP was associated with increased liver stiffness. The increased stiffness is most likely secondary to chronic hepatic venous congestion and/or fibrosis. MRE may be useful for noninvasive liver stiffness assessment in CP. J. Magn. Reson. Imaging 2016;44:81-88.
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Affiliation(s)
- Eric R Fenstad
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Bogdan Dzyubak
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jae K Oh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Phillip M Young
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nandan S Anavekar
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael D Leise
- Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard L Ehman
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Philip A Araoz
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Lurie Y, Webb M, Cytter-Kuint R, Shteingart S, Lederkremer GZ. Non-invasive diagnosis of liver fibrosis and cirrhosis. World J Gastroenterol 2015; 21:11567-11583. [PMID: 26556987 PMCID: PMC4631961 DOI: 10.3748/wjg.v21.i41.11567] [Citation(s) in RCA: 207] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/23/2015] [Accepted: 09/15/2015] [Indexed: 02/07/2023] Open
Abstract
The evaluation and follow up of liver fibrosis and cirrhosis have been traditionally performed by liver biopsy. However, during the last 20 years, it has become evident that this “gold-standard” is imperfect; even according to its proponents, it is only “the best” among available methods. Attempts at uncovering non-invasive diagnostic tools have yielded multiple scores, formulae, and imaging modalities. All are better tolerated, safer, more acceptable to the patient, and can be repeated essentially as often as required. Most are much less expensive than liver biopsy. Consequently, their use is growing, and in some countries the number of biopsies performed, at least for routine evaluation of hepatitis B and C, has declined sharply. However, the accuracy and diagnostic value of most, if not all, of these methods remains controversial. In this review for the practicing physician, we analyze established and novel biomarkers and physical techniques. We may be witnessing in recent years the beginning of the end of the first phase for the development of non-invasive markers. Early evidence suggests that they might be at least as good as liver biopsy. Novel experimental markers and imaging techniques could produce a dramatic change in diagnosis in the near future.
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