Review
Copyright ©The Author(s) 2023.
World J Gastroenterol. Jul 28, 2023; 29(28): 4384-4396
Published online Jul 28, 2023. doi: 10.3748/wjg.v29.i28.4384
Table 1 Advanced magnetic resonance imaging techniques for liver diagnosis: Comparison of clinical applications, advantages, limitations, and developments
Technique(s)
Applications
Advantages
Limitations
Developments
DWI and IVIMAssessment of liver tumors, diffuse liver lesions, and liver function. Assessment of liver or tumor blood perfusionEvaluate liver or tumor blood perfusion without the use of contrast agentsPoor reproducibility of IVIM and DWI2D b-M1 acquisition improves reproducibility. The new parameter PDR improves DWI performance
MREDiagnosis and staging of liver fibrosis and cirrhosis. Prediction of the recurrence of HCCDiagnosis of liver fibrosis is not affected by obesity, ascites, inflammation, and etiologyThe diagnostic threshold for fibrosis is variable and conflictingThe two-step strategy can screen for liver fibrosis. LS and TS can predict HCC recurrence
CESTAssessment of tumor metabolism and microenvironment. Monitoring of tumor treatment responseAn FDG substitute that does not involve ionizing radiationEasily affected by other factors. Long scan timeThe new reagent 3OMG has unique advantages. Realization of image-guided drug delivery and integration of tumor diagnosis and treatment
CE-MRIDiagnosis and staging of liver tumors. Detection of liver metastases and diffuse liver lesionsProvides more information about lesions compared to plain MRI. Specific probes enable visualization at the molecular levelGd chelates can cause allergic reactions and nephrotoxicityMulti-target probes have the potential to overcome tumor heterogeneity. Potential applications of Mn-based contrast agents in targeted tumor therapy
MRSDiagnosis and grading of fatty liver and liver fibrosis. Metabolic evaluation of liver and intrahepatic tumorsProvides quantitative data on liver metabolism non-invasively without the use of contrast agentsLow sensitivity of 13C. Accuracy is affected by liver tissue heterogeneity and motionCho peak can provide more information. 31P-MRS can differentiate liver cirrhosis etiology and evaluate IRI
HP MRProviding metabolic, perfusion, and enzymatic information on HCCDNP improves MR signal by 10000 times. [1-13C] pyruvate has particular value in evaluating tumor metabolismCurrent measurement methods still produce inevitable quantitative deviationsHyperPET is expected to elucidate complete glucose metabolism. More hyperpolarized probes are being used. Double-probe HP MR can simultaneously obtain metabolic and perfusion information
MRI radiomicsDiagnosis and prediction of immunohistochemistry features, MVI, liver fibrosis, and hepatitis.Comprehensive, non-invasive, and quantitative observation of the spatiotemporal heterogeneity of tumorsPoor reproducibility of MRI features. MVI features are variable and conflicting in different studiesGood application value in the differential diagnosis, immunohistochemical feature prediction, and MVI prediction of HCC