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Keegan A, Malamal G, Lee Y, Korolowicz K, Shepard BD, Ecelbarger CM, Rubiano MM, Avantaggiati ML, Levi M, Rich L, Alfano M, Rosenberg A, Fricke S, Albanese C, Jose J, Rodriguez O. Multimodal Diagnostic Imaging of Metabolic Dysfunction-Associated Steatotic Liver Disease: Noninvasive Analyses by Photoacoustic Ultrasound and Magnetic Resonance Imaging. THE AMERICAN JOURNAL OF PATHOLOGY 2025; 195:875-890. [PMID: 39954964 PMCID: PMC12016859 DOI: 10.1016/j.ajpath.2025.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Revised: 01/14/2025] [Accepted: 01/31/2025] [Indexed: 02/17/2025]
Abstract
Chronic diseases of the liver are major public health concerns worldwide. Steatosis and steatohepatitis associated with alcoholic liver disease, metabolic dysfunction-associated fatty liver disease/nonalcoholic fatty liver disease, and hepatitis B and C contribute to chronic diseases of the liver. Liver fibrosis occurs in all forms of advanced chronic diseases of the liver, the confirmation of which is typically performed by needle biopsy. Imaging approaches for liver diagnosis exist but do not provide sufficient diagnostic accuracy for defining the various stages of fibrosis or steatosis. Therefore, there is a need for improved imaging capabilities to enhance disease diagnosis. Ultrasonography-based photoacoustic imaging has recently emerged as a noninvasive, nonionizing modality, capable of capturing structural details and oxygen saturation changes during disease progression. However, its potential for detecting surrogate metabolic dysfunction-associated fatty liver disease markers, such as collagen and lipids, which are often poorly resolved by other conventional imaging techniques, has yet to be investigated in detail. The novelty of this study lies in the innovative use of spectral photoacoustic imaging for the direct detection and quantification of key biomarkers of liver disease, such as fibrosis, collagen, lipids, and oxygenated and deoxygenated hemoglobin, in a mouse model of steatotic fatty liver disease. Ultrasonography-based photoacoustic imaging, validated with magnetic resonance imaging, effectively identified increases in liver adiposity and fibrosis, enabling the noninvasive detection of changes in liver pathology associated with metabolic dysfunction.
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Affiliation(s)
- Alissa Keegan
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | | | - Yichien Lee
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - Kyle Korolowicz
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - Blythe D Shepard
- Department of Human Science, Georgetown University Medical Center, Washington, District of Columbia
| | - Carolyn M Ecelbarger
- Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia
| | - Mariana Moya Rubiano
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - Maria Laura Avantaggiati
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - Moshe Levi
- Department of Biochemistry and Molecular and Cell Biology and Center for Biological and Biomedical Engineering, Georgetown University Medical Center, Washington, District of Columbia
| | - Laurie Rich
- FUJIFILM VisualSonics Inc., Amsterdam, the Netherlands
| | - Massimo Alfano
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, Instituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
| | - Avi Rosenberg
- Genitourinary and Autopsy Divisions, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stanley Fricke
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia; Department of Radiology, Georgetown University Medical Center, Washington, District of Columbia; Center for Translational Imaging, Georgetown University Medical Center, Washington, District of Columbia
| | - Chris Albanese
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia; Department of Radiology, Georgetown University Medical Center, Washington, District of Columbia; Center for Translational Imaging, Georgetown University Medical Center, Washington, District of Columbia.
| | - Jithin Jose
- FUJIFILM VisualSonics Inc., Amsterdam, the Netherlands.
| | - Olga Rodriguez
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia; Center for Translational Imaging, Georgetown University Medical Center, Washington, District of Columbia
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Peng G, Yu B, Luo T, Tao L, Zhang Z. Multi-echo three-dimensional (3D) Dixon sequence combined with disodium gadolinium for risk stratification of advanced fibrosis in metabolic dysfunction-associated steatotic liver disease. Quant Imaging Med Surg 2024; 14:6660-6668. [PMID: 39281147 PMCID: PMC11400654 DOI: 10.21037/qims-24-555] [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: 03/19/2024] [Accepted: 07/19/2024] [Indexed: 09/18/2024]
Abstract
Background The hepatic steatosis and fibrosis related to metabolic dysfunction-associated steatotic liver disease (MASLD) are important factors in the progression. The Multi echo three-dimensional (3D) Dixon sequence can obtain a single breath hold scan for a fat fraction map and an R2* map. The R2* value is usually used to evaluate iron deposition. Whether the change in R2* value is related to liver fibrosis after injection of gadolinium disulfide (Gd) should be noted. This study evaluates the value of enhanced magnetic relaxation time in the risk stratification of liver fibrosis by analyzing the changes in R2* before and after Gd enhancement, and explores the potential application of Multi echo 3D Dixon sequence in one-stop evaluation of MASLD. Methods This retrospective study included 138 MASLD patients who underwent Gadolinum ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) magnetic resonance imaging (MRI) examination in The First Affiliated Hospital of Chongqing Medical University from June 2020 to December 2021. Finally, 90 subjects were divided into moderate and high-risk fibrosis group and low-risk fibrosis group by two-step assessment of liver fibrosis. Multi-echo 3D chemical shift imaging sequence (Q-Dixon) sequences and gradient-echo T1WI (Vibe-Dixon) sequence were performed during the non-enhanced phase and hepatobiliary phase, respectively, and then the signal-intensity enhancement (SE) and magnetic relaxation-time enhancement (RE) values were calculated. The interobserver correlation coefficient was used to evaluate the consistency between observers. Univariate t-test was used to analyze the differences in RE and SE of liver fibrosis among different risk levels. Delong analysis was performed on receiver operating characteristic (ROC) curve to evaluate the difference in diagnostic efficacy between RE and SE in differentiating the risk level of liver fibrosis. Results Among the 90 patients, 55 (61.1%) belonged to the low-risk group and 35 (38.9%) belonged to the medium-to-high-risk group. The average RE and SE values were 1.23±0.15 and 1.57±0.23 in the low-risk group and 0.99±0.09 and 1.38±0.21 in both the medium-to-high-risk group (P<0.01). The ROC curve showed that the area under the curve (AUC) value of RE was 0.922, with a corresponding optimal threshold of 0.713, sensitivity of 0.852, and specificity of 0.861. The AUC value of SE was 0.724, with a corresponding optimal threshold of 0.352, sensitivity of 0.519, and specificity of 0.833. The AUC difference between RE and SE for the predictive value of different risk assessments was 0.198, and the 95% confidence interval of the difference was 0.084-0.312. The Delong test showed that the difference was significant (P<0.01). Conclusions Magnetic RE had high effectiveness for distinguishing between liver-fibrosis risk levels. The combination of the Q-Dixon sequence and Gd-EOB-DTPA has the potential of one-stop evaluation of MASLD.
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Affiliation(s)
- Gang Peng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bin Yu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tianyou Luo
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Tao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhiwei Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Goetz A, Verloh N, Utpatel K, Fellner C, Rennert J, Einspieler I, Doppler M, Luerken L, Alizadeh LS, Uller W, Stroszczynski C, Haimerl M. Differentiating Well-Differentiated from Poorly-Differentiated HCC: The Potential and the Limitation of Gd-EOB-DTPA in the Presence of Liver Cirrhosis. Diagnostics (Basel) 2024; 14:1676. [PMID: 39125552 PMCID: PMC11311873 DOI: 10.3390/diagnostics14151676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 07/30/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024] Open
Abstract
This study uses magnetic resonance imaging (MRI) to investigate the potential of the hepatospecific contrast agent gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) in distinguishing G1- from G2/G3-differentiated hepatocellular carcinoma (HCC). Our approach involved analyzing the dynamic behavior of the contrast agent in different phases of imaging by signal intensity (SI) and lesion contrast (C), to surrounding liver parenchyma, and comparing it across distinct groups of patients differentiated based on the histopathological grading of their HCC lesions and the presence of liver cirrhosis. Our results highlighted a significant contrast between well- and poorly-differentiated lesions regarding the lesion contrast in the arterial and late arterial phases. Furthermore, the hepatobiliary phase showed limited diagnostic value in cirrhotic liver parenchyma due to altered pharmacokinetics. Ultimately, our findings underscore the potential of Gd-EOB-DTPA-enhanced MRI as a tool for improving preoperative diagnosis and treatment selection for HCC while emphasizing the need for continued research to overcome the diagnostic complexities posed by the disease.
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Affiliation(s)
- Andrea Goetz
- Department of Radiology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Niklas Verloh
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Kirsten Utpatel
- Department of Pathology, University Regensburg, 93053 Regensburg, Germany
| | - Claudia Fellner
- Department of Radiology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Janine Rennert
- Department of Radiology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Ingo Einspieler
- Department of Radiology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Michael Doppler
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | - Lukas Luerken
- Department of Radiology, Klinikum Würzburg Mitte, 97074 Würzburg, Germany
| | - Leona S. Alizadeh
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
| | - Wibke Uller
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany
| | | | - Michael Haimerl
- Department of Radiology, Klinikum Würzburg Mitte, 97074 Würzburg, Germany
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Huang W, Peng Y, Kang L. Advancements of non‐invasive imaging technologies for the diagnosis and staging of liver fibrosis: Present and future. VIEW 2024; 5. [DOI: 10.1002/viw.20240010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 06/28/2024] [Indexed: 01/04/2025] Open
Abstract
AbstractLiver fibrosis is a reparative response triggered by liver injury. Non‐invasive assessment and staging of liver fibrosis in patients with chronic liver disease are of paramount importance, as treatment strategies and prognoses depend significantly on the degree of fibrosis. Although liver fibrosis has traditionally been staged through invasive liver biopsy, this method is prone to sampling errors, particularly when biopsy sizes are inadequate. Consequently, there is an urgent clinical need for an alternative to biopsy, one that ensures precise, sensitive, and non‐invasive diagnosis and staging of liver fibrosis. Non‐invasive imaging assessments have assumed a pivotal role in clinical practice, enjoying growing popularity and acceptance due to their potential for diagnosing, staging, and monitoring liver fibrosis. In this comprehensive review, we first delved into the current landscape of non‐invasive imaging technologies, assessing their accuracy and the transformative impact they have had on the diagnosis and management of liver fibrosis in both clinical practice and animal models. Additionally, we provided an in‐depth exploration of recent advancements in ultrasound imaging, computed tomography imaging, magnetic resonance imaging, nuclear medicine imaging, radiomics, and artificial intelligence within the field of liver fibrosis research. We summarized the key concepts, advantages, limitations, and diagnostic performance of each technique. Finally, we discussed the challenges associated with clinical implementation and offer our perspective on advancing the field, hoping to provide alternative directions for the future research.
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Affiliation(s)
- Wenpeng Huang
- Department of Nuclear Medicine Peking University First Hospital Beijing China
| | - Yushuo Peng
- Department of Nuclear Medicine Peking University First Hospital Beijing China
| | - Lei Kang
- Department of Nuclear Medicine Peking University First Hospital Beijing China
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Chen S, Zhuang D, Jia Q, Guo B, Hu G. Advances in Noninvasive Molecular Imaging Probes for Liver Fibrosis Diagnosis. Biomater Res 2024; 28:0042. [PMID: 38952717 PMCID: PMC11214848 DOI: 10.34133/bmr.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/08/2024] [Indexed: 07/03/2024] Open
Abstract
Liver fibrosis is a wound-healing response to chronic liver injury, which may lead to cirrhosis and cancer. Early-stage fibrosis is reversible, and it is difficult to precisely diagnose with conventional imaging modalities such as magnetic resonance imaging, positron emission tomography, single-photon emission computed tomography, and ultrasound imaging. In contrast, probe-assisted molecular imaging offers a promising noninvasive approach to visualize early fibrosis changes in vivo, thus facilitating early diagnosis and staging liver fibrosis, and even monitoring of the treatment response. Here, the most recent progress in molecular imaging technologies for liver fibrosis is updated. We start by illustrating pathogenesis for liver fibrosis, which includes capillarization of liver sinusoidal endothelial cells, cellular and molecular processes involved in inflammation and fibrogenesis, as well as processes of collagen synthesis, oxidation, and cross-linking. Furthermore, the biological targets used in molecular imaging of liver fibrosis are summarized, which are composed of receptors on hepatic stellate cells, macrophages, and even liver collagen. Notably, the focus is on insights into the advances in imaging modalities developed for liver fibrosis diagnosis and the update in the corresponding contrast agents. In addition, challenges and opportunities for future research and clinical translation of the molecular imaging modalities and the contrast agents are pointed out. We hope that this review would serve as a guide for scientists and students who are interested in liver fibrosis imaging and treatment, and as well expedite the translation of molecular imaging technologies from bench to bedside.
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Affiliation(s)
- Shaofang Chen
- Department of Radiology, Shenzhen People’s Hospital (The Second Clinical Medical College,
Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong, China
| | - Danping Zhuang
- Department of Radiology, Shenzhen People’s Hospital (The Second Clinical Medical College,
Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong, China
| | - Qingyun Jia
- Department of Radiology, Shenzhen People’s Hospital (The Second Clinical Medical College,
Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong, China
| | - Bing Guo
- School of Science, Shenzhen Key Laboratory of Flexible Printed Electronics Technology, Shenzhen Key Laboratory of Advanced Functional Carbon Materials Research and Comprehensive Application,
Harbin Institute of Technology, Shenzhen 518055, China
| | - Genwen Hu
- Department of Radiology, Shenzhen People’s Hospital (The Second Clinical Medical College,
Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, Guangdong, China
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Fischer AM, Lechea N, Coxson HO. This Is What Metabolic Dysfunction-Associated Steatotic Liver Disease Looks Like: Potential of a Multiparametric MRI Protocol. Semin Liver Dis 2024; 44:226-238. [PMID: 38806158 DOI: 10.1055/a-2334-8525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent condition with a broad spectrum defined by liver biopsy. This gold standard method evaluates three features: steatosis, activity (ballooning and lobular inflammation), and fibrosis, attributing them to certain grades or stages using a semiquantitative scoring system. However, liver biopsy is subject to numerous restrictions, creating an unmet need for a reliable and reproducible method for MASLD assessment, grading, and staging. Noninvasive imaging modalities, such as magnetic resonance imaging (MRI), offer the potential to assess quantitative liver parameters. This review aims to provide an overview of the available MRI techniques for the three criteria evaluated individually by liver histology. Here, we discuss the possibility of combining multiple MRI parameters to replace liver biopsy with a holistic, multiparametric MRI protocol. In conclusion, the development and implementation of such an approach could significantly improve the diagnosis and management of MASLD, reducing the need for invasive procedures and paving the way for more personalized treatment strategies.
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Affiliation(s)
- Anja M Fischer
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Nazim Lechea
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Harvey O Coxson
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
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Ma B, Xu H, Wu X, Zhu W, Han X, Jiang J, Wang Y, Yang D, Ren H, Yang Z. Evaluation of liver function using Gd-EOB-DTPA-enhanced MRI with T1 mapping. BMC Med Imaging 2023; 23:73. [PMID: 37271809 DOI: 10.1186/s12880-023-01028-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 05/23/2023] [Indexed: 06/06/2023] Open
Abstract
PURPOSE To evaluate the value of MRI T1 mapping with Gd-EOB-DTPA for assessing liver function. METHODS Seventy-two patients who underwent Gd-EOB-DTPA-enhanced MRI for focal liver lesions at Beijing Friendship Hospital from August 2020 to March 2022 were prospectively enrolled, and variable-flip-angle T1 mapping was performed before and 20 min after enhancement. The Child-Pugh (C-P) score and albumin-bilirubin (ALBI) grade of liver function were assessed using the clinical data of the patients. Correlation analysis was used to evaluate the correlation between T1 mapping parameters and liver function grading and laboratory tests. Nonparametric tests were used to compare the differences among different liver function groups. The liver function classification efficiency of each image index was evaluated with receiver operating characteristic (ROC) curves. RESULTS T1post was positively correlated with the C-P grade and the ALBI grade (r = 0.717 and r = 0.652). ΔT1 was negatively correlated with the C-P grade and the ALBI grade (r = -0.790 and r = -0.658). T1post and ΔT1 significantly differed among different liver function grades (p < 0.05). For the C-P grade, T1post and ΔT1 were significantly different between each pair of groups (p < 0.05), and ΔT1 had a better diagnostic efficiency than T1post. For the ALBI grade, ΔT1 and T1post were significantly different between the NLF and ALBI1 groups (p < 0.05), and ΔT1 had a better diagnostic efficacy than T1post. T1post significantly differed between the ALBI1 and ALBI2 + 3 groups (p < 0.05), while ΔT1 had a weak ability to differentiate between these two groups. CONCLUSION T1post and ΔT1 were strongly correlated with the two liver function grades and can be noninvasive imaging indexes for evaluating liver function.
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Affiliation(s)
- Boyang Ma
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, West District, Beijing, 100050, China
| | - Hui Xu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, West District, Beijing, 100050, China
| | - Xinru Wu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, West District, Beijing, 100050, China
| | - Wenyan Zhu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, West District, Beijing, 100050, China
| | - Xinjun Han
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, West District, Beijing, 100050, China
| | - Jiahui Jiang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, West District, Beijing, 100050, China
| | - Yuxin Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, West District, Beijing, 100050, China
| | - Dawei Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, West District, Beijing, 100050, China
| | - Hao Ren
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, West District, Beijing, 100050, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, West District, Beijing, 100050, China.
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Pedersoli F, Boas FE, Park JJ. Temporary Vascular Occlusion with Retrievable Microvascular Plugs to Protect Normal Liver during Yttrium-90 Radioembolization. J Vasc Interv Radiol 2023; 34:978-982. [PMID: 36796477 DOI: 10.1016/j.jvir.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/19/2023] [Accepted: 02/08/2023] [Indexed: 02/17/2023] Open
Abstract
This case series describes a technique to protect nondiseased liver parenchyma during transarterial radioembolization (TARE) using microvascular plugs to occlude nontarget vessels temporarily and protect normal liver. This technique, defined as temporary vascular occlusion, was performed in 6 patients, with complete vessel occlusion obtained in 5 of the 6 patients and partial occlusion with flow reduction in 1 of the 6 patients. A statistically significant (P = .001) dose decrease of 5.7 ± 3.1 times was measured using postadministration yttrium-90 positron emission tomography/computed tomography in the protected zone compared with that in the treated zone.
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Affiliation(s)
- Federico Pedersoli
- Division of Interventional Radiology, Department of Radiology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Franz Edward Boas
- Division of Interventional Radiology, Department of Radiology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - John J Park
- Division of Interventional Radiology, Department of Radiology, City of Hope Comprehensive Cancer Center, Duarte, California.
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Zhang WY, Sun HY, Zhang WL, Feng R. Effect of type 2 diabetes on liver images of GD-EOB-DTPA-enhanced MRI during the hepatobiliary phase. Sci Rep 2023; 13:543. [PMID: 36631556 PMCID: PMC9834214 DOI: 10.1038/s41598-023-27730-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
To analyze alterations of the liver appearance during the hepatobiliary phase of individuals with type 2 diabetes who are receiving gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced magnetic resonance imaging (MRI). Fifty-seven individuals who received Gd-EOB-DTPA-enhanced MRI and had normal liver and renal function but did not have (control group) or have type 2 diabetes (observation group) were retrospectively included in this study. The liver enhancement ratio (LER) and contrast between liver parenchyma and portal vein (LPC) were calculated from hepatobiliary phase images. Utilizing liver to kidney signal intensity, signs of the biliary system, and signs of the portal vein, a functional liver imaging score (FLIS) was calculated. Wilcoxon rank-sum test was used to assess the between-group differences in LER, LPC, and FLIS. FLIS constituent ratios between the two groups were tested using the χ2 test. The effectiveness of LER, LPC, and FLIS for identifying type 2 diabetes was assessed by receiver operating characteristic curves (ROCs). The interobserver consistency of FLIS was evaluated using the intraclass correlation coefficients. The observation group's LER and LPC were lower than the control group. The constituent ratio of the FLIS score (liver to kidney signal intensity, p = 0.011) showed a significant between-group difference. According to ROCs, LER and LPC were associated with the identification of type 2 diabetes. LER = 0.54 and LPC = 1.46 were the optimal cutoff for identifying type 2 diabetes, respectively. FLIS demonstrated excellent inter-reader agreement. The relative signal intensity of the liver during the hepatobiliary phase is decreased in patients with type 2 diabetes. This should be considered when individuals with type 2 diabetes undergo Gd-EOB-DTPA-enhanced MRI to avoid misdiagnoses, such as small hepatocellular carcinoma or abnormal liver function.
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Affiliation(s)
- Wen-Yu Zhang
- grid.410587.fDepartment of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People’s Republic of China
| | - Hao-Yang Sun
- Department of Radiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, No.16369 Jingshi Road, Jinan, 250014, Shandong, People's Republic of China.
| | - Wen-Long Zhang
- grid.410587.fDepartment of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People’s Republic of China
| | - Rui Feng
- grid.410587.fDepartment of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People’s Republic of China
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Kim T, Kim YR, Jeong C, Kim HJ, Kim JW, Lee YH, Yoon K. Regional Analysis of Liver Surface Nodularity in a Single Axial MR Image for Staging Liver Fibrosis. J Magn Reson Imaging 2022; 56:1781-1791. [PMID: 35543163 PMCID: PMC9790718 DOI: 10.1002/jmri.28208] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The assessment of liver surface nodularity (LSN) for staging hepatic fibrosis is restricted in clinical practice because it requires customized software and time-consuming procedures. A simplified method to estimate LSN score may be useful in the clinic. PURPOSE To evaluate the regional analysis of LSN and processing time in a single axial liver MR image for staging liver fibrosis. STUDY TYPE Retrospective. POPULATION A total of 210 subjects, a multicenter study. FIELD STRENGTH/SEQUENCE A 3 T/noncontrast gradient echo T1WI. ASSESSMENT Subjects were divided into five fibrosis groups (F0 = 29; F1 = 20; F2 = 32; F3 = 50; F4 = 79) based on the METAVIR fibrosis scoring system. The mean LSN (on three slices) and regional LSN (on one slice) measurements, and the processing times, are compared. The regional LSN scores in five regions-of-interests (ROI1-5 ) were analyzed in a single axial MRI at the level of the hilum by two independent observers. STATISTICAL TESTS Regional variations in LSN scores were compared using ANOVA with Tukey test. Agreement between the mean and regional LSN measurements was evaluated using Pearson correlation coefficients (r) and Bland-Altman plots. The diagnostic performance of mean and regional LSN scores according to fibrosis stage was evaluated with the AUROC. A P value < 0.05 was considered statistically significant. RESULTS Total processing time for a regional LSN measurement (3.6 min) was 75.5% less than that for mean LSN measurement (14.7 min). Mean LSN scores and all five regional LSN scores showed significant differences between fibrosis groups. Among regional LSN scores, ROI5 showed the highest AUROC (0.871 at cut-off 1.12) for discriminating F0-2 vs. F3-4 and the best correlation with mean LSN score (r = 0.800, -0.07 limit of agreement). CONCLUSION Quantitative regional LSN measurement in a single axial MR image reduces processing time. Regional ROI5 LSN score might be useful for clinical decision-making and for distinguishing the difference between early fibrosis (F0-2 ) and advanced fibrosis (F3-4 ) in the liver. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Tae‐Hoon Kim
- Medical Convergence Research CenterWonkwang UniversityIksanRepublic of Korea
| | - Youe Ree Kim
- Medical Convergence Research CenterWonkwang UniversityIksanRepublic of Korea,Department of RadiologyWonkwang University School of Medicine and Wonkwang University HospitalIksanRepublic of Korea
| | - Chang‐Won Jeong
- Medical Convergence Research CenterWonkwang UniversityIksanRepublic of Korea
| | - Hyung Joong Kim
- Department of Biomedical EngineeringKyung Hee UniversityDongdaemun‐gu, SeoulRepublic of Korea
| | - Jin Woong Kim
- Department of RadiologyChosun University College of Medicine, Chosun University HospitalGwangjuKorea
| | - Young Hwan Lee
- Medical Convergence Research CenterWonkwang UniversityIksanRepublic of Korea,Department of RadiologyWonkwang University School of Medicine and Wonkwang University HospitalIksanRepublic of Korea
| | - Kwon‐Ha Yoon
- Medical Convergence Research CenterWonkwang UniversityIksanRepublic of Korea,Department of RadiologyWonkwang University School of Medicine and Wonkwang University HospitalIksanRepublic of Korea
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Strotzer QD, Winther H, Utpatel K, Scheiter A, Fellner C, Doppler MC, Ringe KI, Raab F, Haimerl M, Uller W, Stroszczynski C, Luerken L, Verloh N. Application of A U-Net for Map-like Segmentation and Classification of Discontinuous Fibrosis Distribution in Gd-EOB-DTPA-Enhanced Liver MRI. Diagnostics (Basel) 2022; 12:1938. [PMID: 36010288 PMCID: PMC9406317 DOI: 10.3390/diagnostics12081938] [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: 06/26/2022] [Revised: 07/31/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
We aimed to evaluate whether U-shaped convolutional neuronal networks can be used to segment liver parenchyma and indicate the degree of liver fibrosis/cirrhosis at the voxel level using contrast-enhanced magnetic resonance imaging. This retrospective study included 112 examinations with histologically determined liver fibrosis/cirrhosis grade (Ishak score) as the ground truth. The T1-weighted volume-interpolated breath-hold examination sequences of native, arterial, late arterial, portal venous, and hepatobiliary phases were semi-automatically segmented and co-registered. The segmentations were assigned the corresponding Ishak score. In a nested cross-validation procedure, five models of a convolutional neural network with U-Net architecture (nnU-Net) were trained, with the dataset being divided into stratified training/validation (n = 89/90) and holdout test datasets (n = 23/22). The trained models precisely segmented the test data (mean dice similarity coefficient = 0.938) and assigned separate fibrosis scores to each voxel, allowing localization-dependent determination of the degree of fibrosis. The per voxel results were evaluated by the histologically determined fibrosis score. The micro-average area under the receiver operating characteristic curve of this seven-class classification problem (Ishak score 0 to 6) was 0.752 for the test data. The top-three-accuracy-score was 0.750. We conclude that determining fibrosis grade or cirrhosis based on multiphase Gd-EOB-DTPA-enhanced liver MRI seems feasible using a 2D U-Net. Prospective studies with localized biopsies are needed to evaluate the reliability of this model in a clinical setting.
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Affiliation(s)
- Quirin David Strotzer
- Department of Diagnostic and Interventional Radiology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Hinrich Winther
- Department of Diagnostic and Interventional Radiology, Hannover University Medical Center, 30625 Hannover, Germany
| | - Kirsten Utpatel
- Institute of Pathology, University of Regensburg, 93053 Regensburg, Germany
| | - Alexander Scheiter
- Institute of Pathology, University of Regensburg, 93053 Regensburg, Germany
| | - Claudia Fellner
- Department of Diagnostic and Interventional Radiology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Michael Christian Doppler
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, 79106 Freiburg im Breisgau, Germany
| | - Kristina Imeen Ringe
- Department of Diagnostic and Interventional Radiology, Hannover University Medical Center, 30625 Hannover, Germany
| | - Florian Raab
- Department of Diagnostic and Interventional Radiology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Michael Haimerl
- Department of Diagnostic and Interventional Radiology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Wibke Uller
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, 79106 Freiburg im Breisgau, Germany
| | - Christian Stroszczynski
- Department of Diagnostic and Interventional Radiology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Lukas Luerken
- Department of Diagnostic and Interventional Radiology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Niklas Verloh
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, 79106 Freiburg im Breisgau, Germany
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12
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Li XH, Huang R, Yang M, Wang J, Gao YH, Jin Q, Ma DL, Wei L, Rao HY. Gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid-enhanced magnetic resonance imaging for evaluating fibrosis regression in chronic hepatitis C patients after direct-acting antiviral. World J Gastroenterol 2022; 28:2214-2226. [PMID: 35721884 PMCID: PMC9157620 DOI: 10.3748/wjg.v28.i20.2214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 03/25/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Direct acting antiviral (DAA) therapy has enabled hepatitis C virus infection to become curable, while histological changes remain uncontained. Few valid non-invasive methods can be confirmed for use in surveillance. Gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid (Gd-EOB-DTPA) is a liver-specific magnetic resonance imaging (MRI) contrast, related to liver function in the hepatobiliary phase (HBP). Whether Gd-EOB-DTPA-enhanced MRI can be used in the diagnosis and follow up of hepatic fibrosis in patients with chronic hepatitis C (CHC) has not been investigated.
AIM To investigate the diagnostic and follow-up values of Gd-EOB-DTPA-enhanced MRI for hepatic histology in patients with CHC.
METHODS Patients with CHC were invited to undergo Gd-EOB-DTPA-enhanced MRI and liver biopsy before treatment, and those with paired qualified MRI and liver biopsy specimens were included. Transient elastography (TE) and blood tests were also arranged. Patients treated with DAAs who achieved 24-wk sustained virological response (SVR) underwent Gd-EOB-DTPA-enhanced MRI and liver biopsy again. The signal intensity (SI) of the liver and muscle were measured in the unenhanced phase (UEP) (SIUEP-liver, SIUEP-muscle) and HBP (SIHBP-liver, SIHBP-muscle) via MRI. The contrast enhancement index (CEI) was calculated as [(SIHBP-liver/SIHBP-muscle)]/[(SIUEP-liver/SIUEP-muscle)]. Liver stiffness measurement (LSM) was confirmed with TE. Serologic markers, aspartate aminotransferase-to-platelet ratio index (APRI) and Fibrosis-4 (FIB-4), were also calculated according to blood tests. The grade of inflammation and stage of fibrosis were evaluated with the modified histology activity index (mHAI) and Ishak fibrosis score, respectively. Fibrosis regression was defined as a ≥ 1-point decrease in the Ishak fibrosis score. The correlation between the CEI and liver pathology was evaluated. The diagnostic and follow-up values of the CEI, LSM, and serologic markers were compared.
RESULTS Thirty-nine patients with CHC were enrolled [average age, 42.3 ± 14.4 years; 20/39 (51.3%) male]. Twenty-one enrolled patients had eligible paired Gd-EOB-DTPA-enhanced MRI and liver tissues after achieving SVR. The mHAI median significantly decreased after SVR [baseline 6.0 (4.5-13.5) vs SVR 2.0 (1.5-5.5), Z = 3.322, P = 0.017], but the median stage of fibrosis did not notably change (P > 0.05). Sixty pairs of qualified MRI and liver tissue samples were available for use to analyze the relationship between the CEI and hepatic pathology. The CEI was negatively correlated with the mHAI (r = -0.56, P < 0.001) and Ishak score (r = -0.69, P < 0.001). Further stratified analysis showed that the value of the CEI decreased with the progression of the stage of fibrosis rather than with the grade of necroinflammation. For patients with Ishak score ≥ 5, the areas under receiver operating characteristics curve of the CEI, LSM, APRI, and FIB-4 were approximately at baseline, 0.87–0.93, and after achieving SVR, 0.83–0.91. The CEI cut-off value was stable (baseline 1.58 and SVR 1.59), but those of the APRI (from 1.05 to 0.24), FIB-4 (from 1.78 to 1.28), and LSM (from 10.8 kpa to 7.1 kpa) decreased dramatically. The APRI and FIB-4 cannot be used as diagnostic means for SVR in patients with Ishak score ≥ 3 (P > 0.05). Seven patients achieved fibrosis regression after achieving SVR. In these patients, the CEI median increased (from 1.71 to 1.83, Z = -1.981, P = 0.048) and those of the APRI (from 1.71 to 1.83, Z = -2.878, P = 0.004) and LSM (from 6.6 to 4.8, Z = -2.366, P = 0.018) decreased. However, in patients without fibrosis regression, the medians of the APRI, FIB-4, and LSM also changed significantly (P < 0.05).
CONCLUSION Gd-EOB-DTPA-enhanced MRI has good diagnostic value for staging fibrosis in patients with CHC. It can be used for fibrotic-change monitoring post SVR in patients with CHC treated with DAAs.
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Affiliation(s)
- Xiao-He Li
- Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology on NAFLD Diagnosis, Peking University People’s Hospital, Beijing 100044, China
| | - Rui Huang
- Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology on NAFLD Diagnosis, Peking University People’s Hospital, Beijing 100044, China
| | - Ming Yang
- Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology on NAFLD Diagnosis, Peking University People’s Hospital, Beijing 100044, China
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing 100044, China
| | - Jian Wang
- Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology on NAFLD Diagnosis, Peking University People’s Hospital, Beijing 100044, China
| | - Ying-Hui Gao
- Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology on NAFLD Diagnosis, Peking University People’s Hospital, Beijing 100044, China
| | - Qian Jin
- Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology on NAFLD Diagnosis, Peking University People’s Hospital, Beijing 100044, China
| | - Dan-Li Ma
- Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology on NAFLD Diagnosis, Peking University People’s Hospital, Beijing 100044, China
| | - Lai Wei
- Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology on NAFLD Diagnosis, Peking University People’s Hospital, Beijing 100044, China
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing 100044, China
| | - Hui-Ying Rao
- Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology on NAFLD Diagnosis, Peking University People’s Hospital, Beijing 100044, China
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Sethasathien S, Leemasawat K, Silvilairat S, Sittiwangkul R, Chattipakorn SC, Chattipakorn N. Screening modalities for the diagnosis of Fontan-associated liver disease: evidence from the past for future development. Am J Transl Res 2022; 14:1433-1453. [PMID: 35422957 PMCID: PMC8991157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 02/06/2022] [Indexed: 06/14/2023]
Abstract
Approximately 70,000 patients who have undergone the Fontan operation worldwide survive into adulthood, however the majority of these patients are faced with long-term post-operative complications due to specific hemodynamic changes. Fontan-associated liver disease (FALD) is a challenging complication characterized by various spectra. Of these, liver congestion and liver fibrosis potentially lead to cirrhosis and liver nodules. The most serious condition associated with the development of liver nodules is hepatocellular carcinoma. Various non-invasive modalities including blood tests, ultrasound scans of the upper abdomen, ultrasound elastography of the liver, computed tomography scans, magnetic resonance imaging and magnetic resonance elastography of the liver have been used as alternatives to liver biopsies for FALD assessment in post-Fontan patients. To date, a detailed understanding of the pathophysiology and natural history of these patients, and the most appropriate modality for the effective investigation of this condition is incomplete. In this comprehensive review, reports regarding the currently available screening modalities used in the detection of FALD are summarized and discussed. The findings of this review, including identification of any current knowledge gaps, can pave the way for the development of effective future strategies in the surveillance and ultimately the treatment of post-Fontan patients.
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Affiliation(s)
- Saviga Sethasathien
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai UniversityChiang Mai 50200, Thailand
| | - Krit Leemasawat
- Division of Cardiovascular Diseases, Department of Medicine, Faculty of Medicine, Chiang Mai UniversityChiang Mai 50200, Thailand
| | - Suchaya Silvilairat
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai UniversityChiang Mai 50200, Thailand
| | - Rekwan Sittiwangkul
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai UniversityChiang Mai 50200, Thailand
| | - Siriporn C Chattipakorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai UniversityChiang Mai 50200, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai UniversityChiang Mai 50200, Thailand
| | - Nipon Chattipakorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai UniversityChiang Mai 50200, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai UniversityChiang Mai 50200, Thailand
- Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai UniversityChiang Mai 50200, Thailand
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14
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Friedman SL, Pinzani M. Hepatic fibrosis 2022: Unmet needs and a blueprint for the future. Hepatology 2022; 75:473-488. [PMID: 34923653 DOI: 10.1002/hep.32285] [Citation(s) in RCA: 246] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 12/12/2022]
Abstract
Steady progress over four decades toward understanding the pathogenesis and clinical consequences of hepatic fibrosis has led to the expectation of effective antifibrotic drugs, yet none has been approved. Thus, an assessment of the field is timely, to clarify priorities and accelerate progress. Here, we highlight the successes to date but, more importantly, identify gaps and unmet needs, both experimentally and clinically. These include the need to better define cell-cell interactions and etiology-specific elements of fibrogenesis and their link to disease-specific drivers of portal hypertension. Success in treating viral hepatitis has revealed the remarkable capacity of the liver to degrade scar in reversing fibrosis, yet we know little of the mechanisms underlying this response. Thus, there is an exigent need to clarify the cellular and molecular mechanisms of fibrosis regression in order for therapeutics to mimic the liver's endogenous capacity. Better refined and more predictive in vitro and animal models will hasten drug development. From a clinical perspective, current diagnostics are improving but not always biologically plausible or sufficiently accurate to supplant biopsy. More urgently, digital pathology methods that leverage machine learning and artificial intelligence must be validated in order to capture more prognostic information from liver biopsies and better quantify the response to therapies. For more refined treatment of NASH, orthogonal approaches that integrate genetic, clinical, and pathological data sets may yield treatments for specific subphenotypes of the disease. Collectively, these and other advances will strengthen and streamline clinical trials and better link histologic responses to clinical outcomes.
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Affiliation(s)
- Scott L Friedman
- Division of Liver DiseasesIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Massimo Pinzani
- Institute for Liver and Digestive HealthUniversity College LondonLondonUK
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15
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Multiple Intestinal Bacteria Associated with the Better Protective Effect of Bifidobacterium pseudocatenulatum LI09 against Rat Liver Injury. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8647483. [PMID: 35127946 PMCID: PMC8816544 DOI: 10.1155/2022/8647483] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/11/2022] [Indexed: 12/12/2022]
Abstract
Bifidobacterium pseudocatenulatum LI09 could protect rats from D-galactosamine- (D-GalN-) induced liver injury. However, individual difference in the protective effects of LI09 on the liver injury remains poorly understood. The present study is aimed at determining the multiple intestinal bacteria associated with the better protective effect of LI09 against D-GalN-induced rat liver injury. Two rat cohorts, i.e., the nonsevere and severe cohorts, were divided based on their liver injury severity. Higher level of ALB and lower levels of ALT, AST, TBA, TB, IL-5, and MIP-3α were determined in the nonsevere cohort than the severe cohort. The alpha diversity indices (i.e., observed species, Shannon, and Pielou indices) did not yield significant differences between the intestinal microbiota of the nonsevere and severe cohorts. The intestinal microbiota composition was different between the two cohorts. Ten phylotypes assigned to Bacteroides, Clostridia_UCG-014, Clostridium Lachnospiraceae, Lachnospiraceae_NK4A136, and Parabacteroides were closely associated with the nonsevere cohort, among which, ASV8_Lachnospiraceae_NK4A136 was the most associated one. At the structure level, two groups of phylotypes with most correlations were determined in the intestinal microbiota networks of the two cohorts. Among them, ASV135_Lachnospiraceae_NK4A136 was the most powerful gatekeeper in the microbiota network of the nonsevere cohort. In conclusion, some intestinal bacteria, e.g., Lachnospiraceae_NK4A136, Parabacteroides, and Clostridium, were associated with the better protective effect of LI09 against D-GalN-induced rat liver injury. They were likely to enhance the effectiveness of LI09, and their clinical application deserves further investigation.
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Gd-EOB-DTPA-enhanced MRI-a noninvasive and short-term assessment method for liver necroinflammation after direct-acting antiviral (DAA) therapy in patients with chronic hepatitis C. Abdom Radiol (NY) 2022; 47:174-183. [PMID: 34664096 DOI: 10.1007/s00261-021-03316-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess liver necroinflammation in HCV patients undergone antiviral therapy by Gd-EOB-DTPA-enhanced MRI with histopathologic analyses as reference. METHODS HCV patients were enrolled in this prospective study before antiviral treatment between 09-2016 and 07-2017. Unenhanced MR, Gd-EOB-DTPA-enhanced MR, and liver biopsy were performed before and 24 weeks after treatment of daclatasvir with asunaprevir (DAA). DWI was obtained using a breath-hold single-shot echo planar spin-echo sequence. Twenty minutes after administration of Gd-EOB-DTPA, the relative enhancement (RE) and the contrast enhancement index (CEI) were recorded. Liver necroinflammatory activity grades (G0-18) were categorized on the Ishak Scoring systems. CEI, RE, and DWI of baseline and 24 weeks after treatment were compared by paired t test. Relationship between MR parameters and histologic scores was evaluated by Pearson's correlation. Receiver operating characteristic analysis evaluated the measurements' diagnostic performance. MRI variability between two readers was assessed using the intraclass correlation coefficient.Results RESULTS: A decrease of liver necroinflammatory activity grade (p < 0.0001) was detected in final cohort (n = 21; mean age 44 years; 23 to 67 years; 11 F, 10 M). Statistical results of 42 person-times in 21 patients at baseline and follow-up showed CEI and ADC were significantly different (p = 0.006 and 0.036) across histologic grades of liver necroinflammation. Significant increase of CEI, RE, and ADC (p = 0.0004, 0.0032, 0.0110) 24 weeks after DAA treatment was seen. Additionally, CEI was correlated to necroinflammatory grade (r = - 0.596, p = 0.006). AUROC for CEI, ADC, and CEI combined with ADC to differentiate patients with none and mild (G0-6) from patients with moderate and severe necroinflammation (G7-18) was 0.834 (95% CI 0.712-0.956, 0.724(95% CI 0.565-0.884) and 0.837(95% CI 0.717-0.956). CONCLUSION Gd-EOB-DTPA-enhanced MRI by CEI could be used as a noninvasive imaging biomarker to distinguish grades of necroinflammatory activity in patients with HCV after DAAs therapy at early stage and CEI combined with ADC could get a better diagnostic accuracy.
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17
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Quantification of contrast agent uptake in the hepatobiliary phase helps to differentiate hepatocellular carcinoma grade. Sci Rep 2021; 11:22991. [PMID: 34837039 PMCID: PMC8626433 DOI: 10.1038/s41598-021-02499-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/10/2021] [Indexed: 12/02/2022] Open
Abstract
This study aimed to assess the degree of differentiation of hepatocellular carcinoma (HCC) using Gd-EOB-DTPA-assisted magnetic resonance imaging (MRI) with T1 relaxometry. Thirty-three solitary HCC lesions were included in this retrospective study. This study's inclusion criteria were preoperative Gd-EOB-DTPA-assisted MRI of the liver and a histopathological evaluation after hepatic tumor resection. T1 maps of the liver were evaluated to determine the T1 relaxation time and reduction rate between the native phase and hepatobiliary phase (HBP) in liver lesions. These findings were correlated with the histopathologically determined degree of HCC differentiation (G1, well-differentiated; G2, moderately differentiated; G3, poorly differentiated). There was no significant difference between well-differentiated (950.2 ± 140.2 ms) and moderately/poorly differentiated (1009.4 ± 202.0 ms) HCCs in the native T1 maps. After contrast medium administration, a significant difference (p ≤ 0.001) in the mean T1 relaxation time in the HBP was found between well-differentiated (555.4 ± 140.2 ms) and moderately/poorly differentiated (750.9 ± 146.4 ms) HCCs. For well-differentiated HCCs, the reduction rate in the T1 time was significantly higher at 0.40 ± 0.15 than for moderately/poorly differentiated HCCs (0.25 ± 0.07; p = 0.006). In conclusion this study suggests that the uptake of Gd-EOB-DTPA in HCCs is correlated with tumor grade. Thus, Gd-EOB-DTPA-assisted T1 relaxometry can help to further differentiation of HCC.
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Oh G, Lee JE, Ye JC. Unpaired MR Motion Artifact Deep Learning Using Outlier-Rejecting Bootstrap Aggregation. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:3125-3139. [PMID: 34133276 DOI: 10.1109/tmi.2021.3089708] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Recently, deep learning approaches for MR motion artifact correction have been extensively studied. Although these approaches have shown high performance and lower computational complexity compared to classical methods, most of them require supervised training using paired artifact-free and artifact-corrupted images, which may prohibit its use in many important clinical applications. For example, transient severe motion (TSM) due to acute transient dyspnea in Gd-EOB-DTPA-enhanced MR is difficult to control and model for paired data generation. To address this issue, here we propose a novel unpaired deep learning scheme that does not require matched motion-free and motion artifact images. Specifically, the first step of our method is k -space random subsampling along the phase encoding direction that can remove some outliers probabilistically. In the second step, the neural network reconstructs fully sampled resolution image from a downsampled k -space data, and motion artifacts can be reduced in this step. Last, the aggregation step through averaging can further improve the results from the reconstruction network. We verify that our method can be applied for artifact correction from simulated motion as well as real motion from TSM successfully from both single and multi-coil data with and without k -space raw data, outperforming existing state-of-the-art deep learning methods.
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19
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Gong X, Wang X, Zhou F. Liver microRNA-29b-3p positively correlates with relative enhancement values of magnetic resonance imaging and represses liver fibrosis. J Biochem 2021; 168:603-609. [PMID: 32653922 DOI: 10.1093/jb/mvaa074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/25/2020] [Indexed: 12/14/2022] Open
Abstract
This study aims to identify potential microRNAs (miRNAs) contribute to liver fibrosis progression and investigate how the miRNA is involved. We recruited totally 58 patients. Magnetic resonance imaging was employed to detect fibrosis. Classification of liver fibrosis was carried out by Ishak scoring system. Cell viability was tested using cell counting kit-8. Measurements of mRNA and protein expressions were conducted using real-time quantitative polymerase chain reaction and western blotting. Luciferase reporter assay was recruited for determination of miR-29b-3p targets. We found that relative enhancement (RE) values were reduced with the increases in fibrosis stages and was negatively associated with Ishak scores. In comparison with patients without liver fibrosis, miR-29b-3p level was remarkably reduced in those with liver fibrosis. Its level was found to be positively associated with RE values. Transforming growth factor beta 1 (TGF-β1)-induced hepatic stellate cell (HSC) activation significantly decreased miR-29b-3p expression. However, miR-29b-3p overexpression repressed TGF-β1-induced collagen I protein and alpha-smooth muscle actin (α-SMA) expression. As expected, its overexpression also reduced cell viability. We found that miR-29b-3p directly bind to signal transducer and activator of transcription 3 (STAT3) and suppressed its expression. Our study demonstrates that low expression of miR-29b-3p may contribute to the progression of liver fibrosis by suppressing STAT3.
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Affiliation(s)
- Xijun Gong
- Department of Radiology, the Second Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui, China
| | - Xiaolin Wang
- Department of Pathology, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Anhui, China
| | - Fangfang Zhou
- Department of Radiology, the Second Affiliated Hospital of Anhui Medical University, Hefei 230000, Anhui, China
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Arutyunyants DE, Khovrin VV, Galyan TN, Kulichkin AS, Tarba NS, Filin AV, Metelin AV. [Magnetic resonance imaging in liver function analysis. Modern objective reality]. Khirurgiia (Mosk) 2021:89-94. [PMID: 34032794 DOI: 10.17116/hirurgia202106289] [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] [Indexed: 02/03/2023]
Abstract
Chronic liver disease is a serious worldwide problem because its progression is accompanied by liver fibrosis and cirrhosis at the terminal stages. Primary diagnosis and dynamic assessment of liver fibrosis are essential to determine the prognosis of disease and optimal treatment strategy. Long-term world experience in the use of gadoxetic acid (primovist, eovist) for diagnosis of liver diseases confirms its hepatotropic properties. Thus, magnetic resonance imaging (MRI) in hepatobiliary phase of contrast enhancement is valuable for differential diagnosis of focal liver lesions and assessment of liver structure and fibrotic changes. This review is devoted to the most common methods of contrast-enhanced MRI for assessment of liver function and correlation between severity of diffuse structural liver changes and gadoxetic acid accumulation in liver parenchyma. There is no a single method for MRI-based analysis of liver function that is confirmed by active researches in this direction. It was found that liver biopsy can by unnecessary in some cases if contrast-enhanced MRI with gadoxetic acid is available. The advantage of gadoxetic acid is also elimination properties. Indeed, biliary excretion ensures T1-weighted MR-cholangiography for additional assessment of patency, function and anatomy of the bile ducts. However, there are still several questions in this area that necessitates further research.
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Affiliation(s)
| | - V V Khovrin
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
| | - T N Galyan
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
| | - A S Kulichkin
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
| | - N S Tarba
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
| | - A V Filin
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
| | - A V Metelin
- Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
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Bi XJ, Zhang XQ, Zhang T, Xu L, Huang AN, Liu MT, Jiang JF, Chen WB. Quantitative assessment of liver function with hepatocyte fraction: Comparison with T1 relaxation-based indices. Eur J Radiol 2021; 141:109779. [PMID: 34029932 DOI: 10.1016/j.ejrad.2021.109779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/11/2021] [Accepted: 05/16/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to assess the use of hepatocyte fraction in gadoxetic acid-enhanced magnetic resonance imaging (MRI) for quantitatively evaluating the liver function in comparison with T1 relaxation-based indices. METHODS This retrospective study included 79 patients with chronic liver disease, who were divided into 2 groups based on the results of the indocyanine green retention test (ICG). All patients underwent a gadoxetic acid-enhanced MRI of the liver. Pre- and post-contrast Look-Locker sequences were used 20 min after gadoxetic acid administration to acquire T1 mapping. Two readers independently identified and measured the MRI parameters [five T1 relaxation-based indices (T1pre, T1post, rrT1, R1post/R1pre and ΔR1) and two hepatocyte fraction indices (HeF and KHep)]. An Independent-samples t test was used to compare each parameter for the two groups. Pearson correlation analysis was used to analyze the correction in each parameter and 15-minute ICG retention rate (ICG-R15). Receiver operating characteristic analyses were performed to differentiate the diagnostic performance of each parameter in ICG-R15 ≤ 20 % and ICG-R15 > 20 % groups. RESULTS T1pre and T1post were significantly lower in the ICG-R15 ≤ 20 % group than in the ICG-R15 > 20 % group (P < 0.05). rrT1, R1post/R1pre, ΔR1, HeF, and KHep were significantly higher in the ICG-R15 ≤ 20 % group than in the ICG-R15 > 20 % group (P < 0.05). The correction coefficients between T1pre, T1post, rrT1, R1post/R1pre, ΔR1, HeF, KHep, and ICG-R15 were 0.343, 0.783, -0.833, -0.781, -0.803, -0.819, and -0.832, respectively. The area under the curves (AUCs) of T1pre, T1post, rrT1, R1post/R1pre, ΔR1, HeF, and KHep in assessing the ICG-R15＞20 % groups were 0.761, 0.945, 0.912, 0.912, 0.948, 0.945, and 0.950, respectively. KHep had the highest AUC, sensitivity, and specificity. CONCLUSION Hepatocyte fraction based on gadoxetic acid-enhanced T1-mapping MRI is an efficient diagnostic tool for the quantitative evaluation of liver function.
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Affiliation(s)
- Xin-Jun Bi
- Department of Radiology, Affiliated Matern & Child Care Hospital of Nantong University, Nantong, 226000, Jiangsu, China
| | - Xue-Qin Zhang
- Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong, 226000, Jiangsu, China.
| | - Tao Zhang
- Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong, 226000, Jiangsu, China
| | - Lei Xu
- Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong, 226000, Jiangsu, China
| | - Ai-Na Huang
- Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong, 226000, Jiangsu, China
| | - Mao-Tong Liu
- Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong, 226000, Jiangsu, China
| | - Ji-Feng Jiang
- Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong, 226000, Jiangsu, China
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Zheng R, Shi C, Wang C, Shi N, Qiu T, Chen W, Shi Y, Wang H. Imaging-Based Staging of Hepatic Fibrosis in Patients with Hepatitis B: A Dynamic Radiomics Model Based on Gd-EOB-DTPA-Enhanced MRI. Biomolecules 2021; 11:307. [PMID: 33670596 PMCID: PMC7922315 DOI: 10.3390/biom11020307] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/13/2021] [Accepted: 02/17/2021] [Indexed: 12/12/2022] Open
Abstract
Accurate grading of liver fibrosis can effectively assess the severity of liver disease and help doctors make an appropriate diagnosis. This study aimed to perform the automatic staging of hepatic fibrosis on patients with hepatitis B, who underwent gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging with dynamic radiomics analysis. The proposed dynamic radiomics model combined imaging features from multi-phase dynamic contrast-enhanced (DCE) images and time-domain information. Imaging features were extracted from the deep learning-based segmented liver volume, and time-domain features were further explored to analyze the variation in features during contrast enhancement. Model construction and evaluation were based on a 132-case data set. The proposed model achieved remarkable performance in significant fibrosis (fibrosis stage S1 vs. S2-S4; accuracy (ACC) = 0.875, area under the curve (AUC) = 0.867), advanced fibrosis (S1-S2 vs. S3-S4; ACC = 0.825, AUC = 0.874), and cirrhosis (S1-S3 vs. S4; ACC = 0.850, AUC = 0.900) classifications in the test set. It was more dominant compared with the conventional single-phase or multi-phase DCE-based radiomics models, normalized liver enhancement, and some serological indicators. Time-domain features were found to play an important role in the classification models. The dynamic radiomics model can be applied for highly accurate automatic hepatic fibrosis staging.
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Affiliation(s)
- Rencheng Zheng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai 200433, China;
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai 200433, China
| | - Chunzi Shi
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201052, China; (C.S.); (N.S.); (T.Q.)
| | - Chengyan Wang
- Human Phenome Institute, Fudan University, Shanghai 200433, China;
| | - Nannan Shi
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201052, China; (C.S.); (N.S.); (T.Q.)
| | - Tian Qiu
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201052, China; (C.S.); (N.S.); (T.Q.)
| | - Weibo Chen
- Market Solutions Center, Philips Healthcare, Shanghai 200072, China;
| | - Yuxin Shi
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201052, China; (C.S.); (N.S.); (T.Q.)
| | - He Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai 200433, China;
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai 200433, China
- Human Phenome Institute, Fudan University, Shanghai 200433, China;
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23
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Noninvasive diagnosis of portal hypertension using gadoxetate DCE-MRI of the liver and spleen. Eur Radiol 2021; 31:4804-4812. [PMID: 33411050 DOI: 10.1007/s00330-020-07495-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/25/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To assess the performance of gadoxetate dynamic contrast-enhanced (DCE) MRI of the liver and spleen for noninvasive diagnosis of portal hypertension (PH). METHODS Thirty-five patients (M/F 22/13, mean age 55 years) with chronic liver disease who underwent hepatic venous pressure gradient (HVPG) measurements were prospectively enrolled in this IRB-approved study. All patients underwent multiparametric MRI including gadoxetate DCE-MRI acquisition. Model-based and model-free DCE-MRI analyses were performed. The correlation between DCE-MRI parameters and HVPG was assessed. ROC analysis was employed to determine the diagnostic performance of DCE-MRI parameters alone and in combination for prediction of PH and clinically significant (CS)PH (HVPG > 5 and ≥ 10 mmHg, respectively). RESULTS Mean HVPG was 7.0 ± 5.0 mmHg (range 0-18 mmHg). Twenty-one (60%) patients had PH, of whom 9 had CSPH. Modeled liver uptake fraction fi and uptake rate ki and model-free parameters liver upslope and uptake were all significantly negatively correlated with HVPG (r range - 0.490 to - 0.398, p value range 0.003-0.018), while spleen interstitial fraction ve was significantly positively correlated with HVPG (r = 0.336, p = 0.048). For PH diagnosis, liver ki showed the best diagnostic performance with an AUC, sensitivity, and specificity of 0.74 (confidence interval (CI) 0.57-0.91), 71.4%, and 78.6%. The combination of liver ki and spleen ve was selected as the best classifier for diagnosis of CSPH with an AUC, sensitivity, and specificity of 0.87 (CI 0.75-0.99), 100%, and 73.1%. CONCLUSIONS Our results demonstrate the potential utility of hepatocyte uptake parameters and spleen interstitial fraction obtained with gadoxetate DCE-MRI for the diagnosis of PH and CSPH. KEY POINTS • Liver uptake and spleen interstitial fraction estimates from gadoxetate DCE-MRI are significantly correlated with portal pressure measurements. • Liver uptake rate shows good diagnostic performance for the diagnosis of portal hypertension. • The combination of liver uptake rate with spleen interstitial fraction exhibits excellent diagnostic performance for the diagnosis of clinically significant portal hypertension.
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24
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Zhou IY, Montesi SB, Akam EA, Caravan P. Molecular Imaging of Fibrosis. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00077-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Zhou IY, Catalano OA, Caravan P. Advances in functional and molecular MRI technologies in chronic liver diseases. J Hepatol 2020; 73:1241-1254. [PMID: 32585160 PMCID: PMC7572718 DOI: 10.1016/j.jhep.2020.06.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 02/06/2023]
Abstract
MRI has emerged as the most comprehensive non-invasive diagnostic tool for liver diseases. In recent years, the value of MRI in hepatology has been significantly enhanced by a wide range of contrast agents, both clinically available and under development, that add functional information to anatomically detailed morphological images, or increase the distinction between normal and pathological tissues by targeting molecular and cellular events. Several classes of contrast agents are available for contrast-enhanced hepatic MRI, including i) conventional non-specific extracellular fluid contrast agents for assessing tissue perfusion; ii) hepatobiliary-specific contrast agents that are taken up by functioning hepatocytes and excreted through the biliary system for evaluating hepatobiliary function; iii) superparamagnetic iron oxide particles that accumulate in Kupffer cells; and iv) novel molecular contrast agents that are biochemically targeted to specific molecular/cellular processes for staging liver diseases or detecting treatment responses. The use of different functional and molecular MRI methods enables the non-invasive assessment of disease burden, progression, and treatment response in a variety of liver diseases. A high diagnostic performance can be achieved with MRI by combining imaging biomarkers.
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Affiliation(s)
- Iris Y Zhou
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States; Harvard Medical School, Boston, MA, USA; Institute for Innovation in Imaging (i(3)), Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Onofrio A Catalano
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States; Harvard Medical School, Boston, MA, USA; Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Peter Caravan
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States; Harvard Medical School, Boston, MA, USA; Institute for Innovation in Imaging (i(3)), Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.
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26
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Yang M, Zhang Y, Zhao W, Cheng W, Wang H, Guo S. Evaluation of liver function using liver parenchyma, spleen and portal vein signal intensities during the hepatobiliary phase in Gd-EOB-D TPA-enhanced MRI. BMC Med Imaging 2020; 20:119. [PMID: 33081713 PMCID: PMC7576754 DOI: 10.1186/s12880-020-00519-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 10/08/2020] [Indexed: 12/14/2022] Open
Abstract
Background Previous studies have used signal intensity (SI) to reflect liver function. However, few studies have evaluated liver function via the portal vein. Regarding the SI of the liver, spleen, and portal vein, no study has indicated which can best reflect liver function. Therefore, the aim of this study is to investigate whether these parameters can evaluate liver function in patients with cirrhosis and determine which is the best parameter.
Methods 120 patients with normal livers (n = 41) or Child–Pugh class A (n = 50), B (n = 21) or C (n = 8) disease who had undergone Gd-EOB-DTPA-enhanced MRI were retrospectively reviewed. Comparisons of the MRI data (liver parenchyma SI, portal vein SI, and spleen SI and liver-to-portal vein contrast ratio (LPC), liver-to-spleen contrast ratio (LSC), and portal vein-to-spleen contrast ratio (PSC)) in the 15-min hepatobiliary phase images were performed among the groups, and the correlations among the liver function parameters (total bilirubin, direct bilirubin, indirect bilirubin, aspartate aminotransferase, alanine aminotransferase, albumin, creatinine, platelet count, prothrombin time and international normalized ratio), liver function scores and MRI data were also quantitatively analysed. Results Significant differences were observed in the liver parenchyma SI, LPC and LSC among the groups. These values all decreased gradually from normal livers to Child–Pugh class C cirrhotic livers (P < 0.001). The portal vein SI constantly and slightly increased from normal livers to Child–Pugh class C cirrhotic livers, but no differences were found among the groups in the portal vein SI and PSC (P > 0.05). LPC showed a stronger correlation with the Child–Pugh score and MELD score than LSC and the liver parenchyma SI. The order of the AUCs of these parameters, from largest to smallest, was as follows: LPC, LSC, and liver parenchyma SI (P > 0.05). Conclusion The liver parenchyma SI, LSC and LPC may be used as alternative imaging biomarkers to assess liver function, while the portal vein SI and PSC do not reflect liver function. Furthermore, LPC values can more effectively distinguish severity among patients with cirrhosis than the liver parenchyma SI and LSC.
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Affiliation(s)
- Ming Yang
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Sanxiang Street No. 1055, Suzhou, 215004, Jiangsu, China
| | - Yue Zhang
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Sanxiang Street No. 1055, Suzhou, 215004, Jiangsu, China
| | - Wenlu Zhao
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Sanxiang Street No. 1055, Suzhou, 215004, Jiangsu, China
| | - Wen Cheng
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Sanxiang Street No. 1055, Suzhou, 215004, Jiangsu, China
| | - Han Wang
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Sanxiang Street No. 1055, Suzhou, 215004, Jiangsu, China
| | - Shengren Guo
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Sanxiang Street No. 1055, Suzhou, 215004, Jiangsu, China.
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Caussy C, Johansson L. Magnetic resonance-based biomarkers in nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Endocrinol Diabetes Metab 2020; 3:e00134. [PMID: 33102797 PMCID: PMC7576227 DOI: 10.1002/edm2.134] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 02/16/2020] [Accepted: 03/14/2020] [Indexed: 12/11/2022] Open
Abstract
Nonalcoholic fatty liver disease is a growing epidemic affecting 30% of the adult population in the Western world. Its progressive form, nonalcoholic steatohepatitis (NASH), is associated with an increased risk of advanced fibrosis, cirrhosis and liver-related mortality. Therefore, the detection of NAFLD and risk stratification according to the severity of the disease is crucial for the management of patients with NAFLD. Liver biopsy for such risk stratification strategies is limited by its cost and risks; therefore, noninvasive alternatives have been developed. Among noninvasive biomarkers developed in NAFLD, magnetic resonance (MR)-based biomarkers have emerged as key noninvasive biomarkers in NAFLD with the ability to accurately detect hepatic steatosis and liver fibrosis. The potential utility of MRI for the detection of NASH and functional liver assessment has also recently emerged. In the current review, we will discuss the data supporting the utility of MR-based biomarker for the detection of features of NAFLD and its potential use in clinical practice and clinical research in NAFLD.
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Affiliation(s)
- Cyrielle Caussy
- Univ LyonCarMen LaboratoryINSERMINRAINSA LyonUniversité Claude Bernard Lyon 1Pierre‐BéniteFrance
- Hospices Civils de LyonDépartement EndocrinologieDiabète et NutritionHôpital Lyon SudPierre‐BéniteFrance
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28
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Michalik K, Beyer L, Zeman F, Wendl C, Rennert J, Fellner C, Stroszczynski C, Wiggermann P. Signal intensity in the dentate nucleus after cumulative dose of Gd-EOB-DTPA: First results of a prospective longitudinal study. Clin Hemorheol Microcirc 2020; 76:233-240. [PMID: 32925023 DOI: 10.3233/ch-209219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) is a hepatocyte-specific, linear ionic contrast agent for MRI. In comparison to other linear contrast agents Gd-EOB-DTPA is excreted equally through liver and kidneys. This prospective longitudinal study investigates the signal intensity (SI) in the dentate nucleus (DN) on unenhanced T1-weighted images after repetitive application of Gd-EOB-DTPA. 46 patients were included into the study and 107 MRI examinations were performed. Statistical analysis of 25 patients showed no significant correlation between cumulative dose of Gd-EOB-DTPA and SI change and between the DN/Pons ratiolast and the mean DN/Pons ratiofirst. Subgroup analysis however revealed a significant correlation for one out of two readers. Gd-EOB-DTPA deposition could not be proven in the framework of this study.
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Affiliation(s)
| | - Lukas Beyer
- Department of Radiology, Hospital Potsdam, Potsdam, Germany
| | - Florian Zeman
- Center for Clinical Trials, University Hospital Regensburg, Regensburg, Germany
| | - Christina Wendl
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Janine Rennert
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Claudia Fellner
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
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29
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Winther H, Hundt C, Ringe KI, Wacker FK, Schmidt B, Jürgens J, Haimerl M, Beyer LP, Stroszczynski C, Wiggermann P, Verloh N. A 3D Deep Neural Network for Liver Volumetry in 3T Contrast-Enhanced MRI. ROFO-FORTSCHR RONTG 2020; 193:305-314. [PMID: 32882724 DOI: 10.1055/a-1238-2887] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE To create a fully automated, reliable, and fast segmentation tool for Gd-EOB-DTPA-enhanced MRI scans using deep learning. MATERIALS AND METHODS Datasets of Gd-EOB-DTPA-enhanced liver MR images of 100 patients were assembled. Ground truth segmentation of the hepatobiliary phase images was performed manually. Automatic image segmentation was achieved with a deep convolutional neural network. RESULTS Our neural network achieves an intraclass correlation coefficient (ICC) of 0.987, a Sørensen-Dice coefficient of 96.7 ± 1.9 % (mean ± std), an overlap of 92 ± 3.5 %, and a Hausdorff distance of 24.9 ± 14.7 mm compared with two expert readers who corresponded to an ICC of 0.973, a Sørensen-Dice coefficient of 95.2 ± 2.8 %, and an overlap of 90.9 ± 4.9 %. A second human reader achieved a Sørensen-Dice coefficient of 95 % on a subset of the test set. CONCLUSION Our study introduces a fully automated liver volumetry scheme for Gd-EOB-DTPA-enhanced MR imaging. The neural network achieves competitive concordance with the ground truth regarding ICC, Sørensen-Dice, and overlap compared with manual segmentation. The neural network performs the task in just 60 seconds. KEY POINTS · The proposed neural network helps to segment the liver accurately, providing detailed information about patient-specific liver anatomy and volume.. · With the help of a deep learning-based neural network, fully automatic segmentation of the liver on MRI scans can be performed in seconds.. · A fully automatic segmentation scheme makes liver segmentation on MRI a valuable tool for treatment planning.. CITATION FORMAT · Winther H, Hundt C, Ringe KI et al. A 3D Deep Neural Network for Liver Volumetry in 3T Contrast-Enhanced MRI. Fortschr Röntgenstr 2021; 193: 305 - 314.
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Affiliation(s)
- Hinrich Winther
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Christian Hundt
- Institute for Computer Science, Johannes Gutenberg University, Mainz, Germany
| | - Kristina Imeen Ringe
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Frank K Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Bertil Schmidt
- Institute for Computer Science, Johannes Gutenberg University, Mainz, Germany
| | - Julian Jürgens
- Department of Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Haimerl
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Lukas Philipp Beyer
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | | | - Philipp Wiggermann
- Department of Radiology and Nuclear Medicine, Hospital Braunschweig, Germany
| | - Niklas Verloh
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
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Tanaka T, Nishida H, Mie K, Yamazaki H, Lin LS, Akiyoshi H. Assessment of hepatitis and fibrosis using Gd-EOB-DTPA MRI in dogs. Vet Rec Open 2020; 7:e000371. [PMID: 32818058 PMCID: PMC7401995 DOI: 10.1136/vetreco-2019-000371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 07/01/2020] [Accepted: 07/03/2020] [Indexed: 01/27/2023] Open
Abstract
Background Gadoxetate sodium (Gd-EOB-DTPA) is taken into hepatocytes and excreted into the bile. Hepatocytes with reduced function or dysfunction due to hepatocellular carcinoma (HCC), hepatitis or hepatic fibrosis show impaired Gd-EOB-DTPA uptake. The purpose of the present retrospective case series was to assess the relationship between liver function and contrast enhancement using Gd-EOB-DTPA MRI. Methods Sixteen dogs with a histopathological diagnosis of liver disease, including six with HCC, three with nodular hyperplasia, two with hepatocellular adenoma, two with liver fibrosis and three with hepatitis were included in the study along with three dogs with suspected liver disease but no histopathological diagnosis of liver disease. Relative signal intensities (RSI) of the common bile duct and gall bladder were calculated, and their relationship with the following serum biochemical parameters was assessed: total bilirubin, alanine transaminase, alkaline phosphatase and albumin (Alb). To assess anatomical liver function, relative contrast enhancement indices (RCEI) of the liver were calculated, and differences were assessed between normal and diseased liver. Results RSI showed no significant differences between dogs without and with a histopathological diagnosis of liver disease (P=0.88) although they were significantly correlated with Alb (ρ=0.57, P=0.02) in dogs with a histopathological diagnosis of liver disease. RCEI was significantly higher in normal liver tissue than that in livers with hepatitis/fibrosis (P=0.048) and HCC (P=0.03) but not nodular hyperplasia/hepatocellular adenoma (P=0.51). Conclusions Gd-EOB-DTPA MRI may be potentially useful in the assessment of anatomical liver function in dogs with liver disease.
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Affiliation(s)
- Toshiyuki Tanaka
- Laboratory of Veterinary Surgery, Department of Veterinary Clinical Medicine, Graduate School of Life and Environmental Sciences, Osaka Prefecture University - Rinku Campus, Izumisano, Osaka, Japan.,Kinki Animal Medical Training Institute & Veterinary Clinic, Higashiosaka, Osaka, Japan
| | - Hidetaka Nishida
- Laboratory of Veterinary Surgery, Department of Veterinary Clinical Medicine, Graduate School of Life and Environmental Sciences, Osaka Prefecture University - Rinku Campus, Izumisano, Osaka, Japan
| | - Keiichiro Mie
- Laboratory of Veterinary Surgery, Department of Veterinary Clinical Medicine, Graduate School of Life and Environmental Sciences, Osaka Prefecture University - Rinku Campus, Izumisano, Osaka, Japan
| | - Hiroki Yamazaki
- Laboratory of Veterinary Surgery, Department of Veterinary Clinical Medicine, Graduate School of Life and Environmental Sciences, Osaka Prefecture University - Rinku Campus, Izumisano, Osaka, Japan
| | - Lee-Shuan Lin
- Laboratory of Veterinary Diagnostic Imaging, Department of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - Hideo Akiyoshi
- Laboratory of Veterinary Surgery, Department of Veterinary Clinical Medicine, Graduate School of Life and Environmental Sciences, Osaka Prefecture University - Rinku Campus, Izumisano, Osaka, Japan
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Kromrey ML, Le Bihan D, Ichikawa S, Motosugi U. Diffusion-weighted MRI-based Virtual Elastography for the Assessment of Liver Fibrosis. Radiology 2020; 295:127-135. [DOI: 10.1148/radiol.2020191498] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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32
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Nakajima K, Seki M, Hatakeyama S, Arai S, Asami Y, Tanaka K, Ikeda K, Shimoyama S, Kobayashi T, Miyamoto T, Okada Y, Arakawa H, Takizawa T. Visual liver assessment using Gd-EOB-DTPA-enhanced magnetic resonance imaging of patients in the early post-Fontan period. Sci Rep 2020; 10:4909. [PMID: 32184466 PMCID: PMC7078263 DOI: 10.1038/s41598-020-61618-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 03/02/2020] [Indexed: 11/09/2022] Open
Abstract
No imaging modality can be used to evaluate Fontan-associated liver disease (FALD). We retrospectively reviewed hepatic gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) characteristics of patients within 1 year post-Fontan procedure, and we evaluated the association between hepatic imaging abnormalities and clinical parameters, including follow-up cardiac catheterization and laboratory test findings. The EOB-MR images were graded, based on the extent of the decreased enhancement, as “normal” (Grade 1), “segmental” (Grade 2), “regional” (Grade 3), and “diffuse” (Grade 4). We enrolled 37 patients (mean age, 3.5 ± 1.0 years): 9 patients had Grade 1 or 2; 14 patients, Grade 3; and 14 patients, Grade 4. EOB-MRI revealed characteristic reticular or mosaic patterns of diminished enhancement (i.e. “frog spawn” appearance). Ultrasonography did not detect diminished enhancement or “frog spawn” appearance. A trend existed toward increased grade severity in imaging with increased central venous pressure, pulmonary vascular resistance, and gamma-glutamyltransferase levels. Noninvasive EOB-MRI revealed the characteristic pattern of diminished enhancement, which was correlated with certain clinical parameters indicative of Fontan physiology and liver dysfunction. Early-stage FALD may occur soon after the Fontan procedure and is associated with increased pressure in the inferior vena cava and hepatic veins.
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Affiliation(s)
- Kimiko Nakajima
- Department of Cardiology, Gunma Children's Medical Center, Gunma, Japan.,Department of Pediatrics, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Mitsuru Seki
- Department of Cardiology, Gunma Children's Medical Center, Gunma, Japan
| | | | - Shuhei Arai
- Department of Cardiology, Gunma Children's Medical Center, Gunma, Japan
| | - Yuji Asami
- Department of Cardiology, Gunma Children's Medical Center, Gunma, Japan
| | - Kensuke Tanaka
- Department of Cardiology, Gunma Children's Medical Center, Gunma, Japan
| | - Kentaro Ikeda
- Department of Cardiology, Gunma Children's Medical Center, Gunma, Japan
| | - Shinya Shimoyama
- Department of Cardiology, Gunma Children's Medical Center, Gunma, Japan
| | - Tomio Kobayashi
- Department of Cardiology, Gunma Children's Medical Center, Gunma, Japan
| | - Takashi Miyamoto
- Department of Cardiovascular Surgery, Gunma Children's Medical Center, Gunma, Japan
| | - Yasunori Okada
- Department of Pediatrics, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Hirokazu Arakawa
- Department of Pediatrics, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Takumi Takizawa
- Department of Pediatrics, Gunma University Graduate School of Medicine, Gunma, Japan.
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Yang D, Li D, Li J, Yang Z, Wang Z. Systematic review: The diagnostic efficacy of gadoxetic acid-enhanced MRI for liver fibrosis staging. Eur J Radiol 2020; 125:108857. [PMID: 32113153 DOI: 10.1016/j.ejrad.2020.108857] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 12/07/2019] [Accepted: 01/27/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate the diagnostic efficacy of gadoxetic acid-enhanced MRI for the staging of liver fibrosis by meta-analysis. METHODS PubMed/Medline, EMBASE, the Web of Science, and the Cochrane Library were searched. Studies were included according to their eligibility and the exclusion criteria. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to assess the methodologic quality. The bivariate random-effects model was used to obtain the pooled summary estimates, heterogeneity, and the area under summary receiver operating characteristic curves (AUROC). Meta-regression was performed to discover the source of heterogeneity and compare certain some subsets for their capacity to stage hepatic fibrosis by AUROC comparison. RESULTS A total of 20 original articles (1936 patients) were included. Most studies had a low risk of bias and minimal concerns regarding applicability. The summary AUROC values of gadoxetic acid-enhanced MRI in staging the liver fibrosis ≥ F1, ≥ F2, ≥ F3, and F4 subsets were 0.92, 0.87, 0.89, and 0.91, respectively. Studies with populations equal to or more than 100 had a significantly higher sensitivity (84 %) and specificity (91 %) than those with populations less than 100 (70 % and 77 %, respectively, P < 0.01). Studies of a prospective design exhibited a significantly higher sensitivity (94 %) and specificity (94 %) than those of a retrospective design (75 % and 84 %, respectively, P < 0.01). CONCLUSIONS Our meta-analysis shows the high diagnostic efficacy of gadoxetic acid-enhanced MRI in the staging of liver fibrosis. A prospective study with more than one hundred patients showed higher diagnostic efficacy.
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Affiliation(s)
- Dawei Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China; Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, Beijing 100050, China.
| | - Dan Li
- Department of Radiology, Beijing Changping Hospital, Beijing 102200, China.
| | - Jinshui Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
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Assessment of liver fibrosis with gadoxetic acid-enhanced MRI: comparisons with transient elastography, ElastPQ, and serologic fibrosis markers. Abdom Radiol (NY) 2019; 44:2769-2780. [PMID: 31041497 DOI: 10.1007/s00261-019-02041-z] [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: 12/16/2022]
Abstract
OBJECTIVES To compare the diagnostic performance of gadoxetic acid-enhanced magnetic resonance imaging (MRI), ultrasonography (US)-based elastography, and serologic fibrosis markers in assessing the stage of liver fibrosis. MATERIALS AND METHODS This retrospective study included 67 patients (55 male and 12 female; mean age 62.5 years) who underwent gadoxetic acid-enhanced MRI and liver stiffness measurements before liver biopsy or surgery between January 2014 and January 2018. Measurements were performed using transient elastography (TE), ultrasound shear wave elastography point quantification (ElastPQ), and blood tests. The following MRI-based fibrosis markers were assessed: contrast enhancement index (CEI), liver-spleen contrast ratio (LSC), liver-portal vein contrast ratio (LPC), and signal intensity ratio (SIR). The diagnostic performances of fibrosis markers were compared using the area under the receiver operating characteristic curve (AUC), with histopathologic fibrosis stage as the reference standard. RESULTS The fibrosis stages were F0-F1 (n = 17), F2 (n = 7), F3 (n = 20), and F4 (n = 23). MRI-based fibrosis markers negatively correlated with histologic stage: CEI (r = -0.786); LSC (r = - 0.718); LPC (r = - 0.448); and SIR (r = - 0.617; all P < 0.001). For diagnosis of either significant liver fibrosis (≥ F2) or cirrhosis (F4), the CEI provided better diagnostic accuracy (AUC = 0.898 and 0.881) than the aspartate aminotransferase-to-platelet ratio index (APRI) (AUC = 0.699 and 0.715; all P < 0.05). The CEI displayed similar diagnostic accuracy for ≥ F2 or F4 when using TE (AUC = 0.866 and 0.884, both P > 0.05) or ElastPQ [AUC = 0.751 (P = 0.021) and AUC = 0.786 (P = 0.234)]. CONCLUSIONS The CEI measured by gadoxetic acid-enhanced MRI allows the staging of liver fibrosis, with a diagnostic accuracy comparable to that of TE and superior to that of ElastPQ or APRI.
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Gallium-68-Labelled Indocyanine Green as a Potential Liver Reserve Imaging Agent. CONTRAST MEDIA & MOLECULAR IMAGING 2019; 2019:4201353. [PMID: 31316307 PMCID: PMC6604488 DOI: 10.1155/2019/4201353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/19/2019] [Accepted: 04/23/2019] [Indexed: 12/28/2022]
Abstract
Objective This work evaluated the potential of 68Ga-labelledNOTA-ICG (1,4,7-triazacyclononane-1,4,7-triacetic acid indocyanine green) for liver reserve imaging. Methods To determine the optimal conditions for generating 68Ga-NOTA-ICG, various reaction parameters were implemented. Quality control analysis was performed using different chromatography techniques. The in vitro and in vivo stability was also measured at specific time points. The radioactivity ratio between n-octanol and water was determined to evaluate the water solubility of 68Ga-NOTA-ICG. The plasma-protein binding rate of the labelled compound was determined by the methanol method. The biodistribution and imaging findings were evaluated in normal animals at different time points after injection. A preliminary imaging evaluation was performed using an animal model of hepatic ischaemia-reperfusion injury, which was confirmed by pathology. Results 68Ga-NOTA-ICG was prepared with very high radiochemical purity (>98%) by reacting at 90°C for 10 min at pH = 3.5∼4.0, with excellent stability in vivo and in vitro (>95% 3 h postpreparation). The in vitro plasma-protein binding rate of 68Ga-NOTA-ICG was 13.01 ± 0.7%, and it showed strong water solubility (log P=-2.01 ± 0.04). We found that in addition to excretion through the biliary tract and intestines, 68Ga-NOTA-ICG can be excreted through the urinary tract. The image quality of 68Ga-NOTA-ICG was very high; imaging agent retained in the area of liver injury could clearly be observed. Conclusion This is the first report on a 68Ga-labelled NOTA-ICG fragment for liver reserve function studies. This complex has promise as a candidate agent for liver reserve imaging.
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Verloh N, Probst U, Utpatel K, Zeman F, Brennfleck F, Werner JM, Fellner C, Stroszczynski C, Evert M, Wiggermann P, Haimerl M. Influence of hepatic fibrosis and inflammation: Correlation between histopathological changes and Gd-EOB-DTPA-enhanced MR imaging. PLoS One 2019; 14:e0215752. [PMID: 31083680 PMCID: PMC6513096 DOI: 10.1371/journal.pone.0215752] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 04/08/2019] [Indexed: 02/07/2023] Open
Abstract
Objective To evaluate the influence of an active inflammatory process in the liver on Gd-EOB-DTPA-enhanced MR imaging in patients with different degrees of fibrosis/cirrhosis. Material and methods Overall, a number of 91 patients (61 men and 30 women; mean age 58 years) were included in this retrospective study. The inclusion criteria for this study were Gd-EOB-DTPA-enhanced MRI of the liver and histopathological evaluation of fibrotic and inflammatory changes. T1-weighted VIBE sequences of the liver with fat suppression were evaluated to determine the relative signal change (RE) between native and hepatobiliary phase (20min). In simple and multiple linear regression analyses, the influence of liver fibrosis/cirrhosis (Ishak score) and the histopathological degree of hepatitis (Modified Hepatic Activity Index, mHAI) on RE were evaluated. Results RE decreased significantly with increasing liver fibrosis/cirrhosis (p < 0.001) and inflammation (mHAI, p = 0.004). In particular, a correlation between RE and periportal or periseptal boundary zone hepatitis (moth feeding necrosis, mHAI A, p = 0.001) and portal inflammation (mHAI D, p < 0.001) was observed. In multiple linear regression analysis, both the degree of inflammation and the degree of fibrosis were significant predictors for RE (p < 0.01). Conclusion The results of this study suggest that the MR-based hepatic enhancement index RE is not only influenced by the degree of fibrosis, but also by the degree of inflammation.
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Affiliation(s)
- N. Verloh
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
- * E-mail:
| | - U. Probst
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - K. Utpatel
- Department of Pathology, University Regensburg, Regensburg, Germany
| | - F Zeman
- Center for Clinical Trials, University Hospital Regensburg, Regensburg, Germany
| | - F. Brennfleck
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - J. M. Werner
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - C. Fellner
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - C. Stroszczynski
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - M. Evert
- Department of Pathology, University Regensburg, Regensburg, Germany
| | - P. Wiggermann
- Department of Radiology and Nuclear Medicine, Hospital Braunschweig, Braunschweig, Germany
| | - M. Haimerl
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
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Park HJ, Lee SS, Park B, Yun J, Sung YS, Shim WH, Shin YM, Kim SY, Lee SJ, Lee MG. Radiomics Analysis of Gadoxetic Acid-enhanced MRI for Staging Liver Fibrosis. Radiology 2018; 290:380-387. [PMID: 30615554 DOI: 10.1148/radiol.2018181197] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose To develop and validate a radiomics-based model for staging liver fibrosis by using gadoxetic acid-enhanced hepatobiliary phase MRI. Materials and Methods In this retrospective study, 436 patients (mean age, 51 years; age range, 18-86 years; 319 men [mean age, 51 years; age range, 18-86 years]; 117 women [mean age, 50 years; age range, 18-79 years]) with pathologic analysis-proven liver fibrosis who underwent gadoxetic acid-enhanced MRI from June 2015 to December 2016 were randomized in a three-to-one ratio into development (n = 329) and test (n = 107) cohorts, respectively. In the development cohort, a model was developed to calculate radiomics fibrosis index (RFI) by using logistic regression with elastic net regularization to differentiate stage F3-F4 from stage F0-F2. Optimal RFI cutoffs to diagnose clinically significant fibrosis (stage F2-F4), advanced fibrosis (stage F3-F4), and cirrhosis (stage F4) were determined by receiver operating characteristic curve analysis. In the test cohort, the diagnostic performance of RFI was compared with that of normalized liver enhancement, aspartate transaminase-to-platelet ratio index (APRI), and fibrosis-4 index by using the Obuchowski index. Results In the test cohort, RFI (Obuchowski index, 0.86) significantly outperformed normalized liver enhancement (Obuchowski index, 0.77; P < .03), APRI (Obuchowski index, 0.60; P < .001), and fibrosis-4 index (Obuchowski index, 0.62; P < .001) for staging liver fibrosis. By using the cutoffs, RFI had sensitivities and specificities as follows: 81% (95% confidence interval: 71%, 89%) and 78% (95% confidence interval: 63%, 89%) for diagnosing stage F2-F4, respectively; 79% (95% confidence interval: 67%, 88%) and 82% (95% confidence interval: 69%, 91%), respectively, for diagnosing stage F3-F4; and 92% (95% confidence interval: 79%, 98%) and 75% (95% confidence interval: 62%, 83%), respectively, for diagnosing stage F4. Conclusion Radiomics analysis of gadoxetic acid-enhanced hepatobiliary phase images allows for accurate diagnosis of liver fibrosis. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Hyo Jung Park
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
| | - Seung Soo Lee
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
| | - Bumwoo Park
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
| | - Jessica Yun
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
| | - Yu Sub Sung
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
| | - Woo Hyun Shim
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
| | - Yong Moon Shin
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
| | - So Yeon Kim
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
| | - So Jung Lee
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
| | - Moon-Gyu Lee
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
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Cai Y, Huang MP, Wang XF, Lu X, Luo L, Shu J. Quantitative analysis of susceptibility-weighted magnetic resonance imaging in chronic hepatitis in rats. Magn Reson Imaging 2018; 54:71-76. [DOI: 10.1016/j.mri.2018.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 08/01/2018] [Accepted: 08/17/2018] [Indexed: 02/07/2023]
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Xiao MJ, Xiao EH. Staging of liver fibrosis using Gd-EOB-DTPA and Gd-BOPTA enhanced magnetic resonance imaging. Shijie Huaren Xiaohua Zazhi 2018; 26:1907-1913. [DOI: 10.11569/wcjd.v26.i33.1907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The severity of cirrhosis is closely related to its clinical treatment. Therefore, it is important to stage liver fibrosis accurately. Although liver biopsy can accurately stage the degree of cirrhosis, it has certain limitations in clinical application because of its invasive nature. Magnetic resonance imaging (MRI) has been used in the diagnosis of liver diseases. In recent years, two new contrast agents, gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) and gadobenate dimeglumine (Gd-BOPTA), have been successfully used for noninvasive liver imaging. They can be used for liver fibrosis staging and assessment of liver function. Cirrhotic patients with different liver function levels have a statistical difference in the liver parenchyma enhancement after giving contrast agents. This article briefly summarizes the progress of Gd-EOB-DTPA and Gd-BOPTA enhanced MRI in staging liver fibrosis stage.
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Affiliation(s)
- Man-Jun Xiao
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - En-Hua Xiao
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
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Zhang W, Wang X, Miao Y, Hu C, Zhao W. Liver function correlates with liver-to-portal vein contrast ratio during the hepatobiliary phase with Gd-EOB-DTPA-enhanced MR at 3 Tesla. Abdom Radiol (NY) 2018; 43:2262-2269. [PMID: 29476347 DOI: 10.1007/s00261-018-1462-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSES To determine if liver-to-portal vein contrast ratio (LPC) correlates with liver function in patients with hepatitis B virus (HBV)-related cirrhosis on gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid (Gd-EOB-DTPA)-enhanced MR imaging. METHODS A total of 92 patients with normal (n = 20) or HBV-related cirrhotic livers graded by Child-Pugh class A (n = 50), B (n = 17) or C (n = 5) who underwent Gd-EOB-DTPA-enhanced 3Tesla MR imaging were retrospectively reviewed. LPC was defined as the signal intensity ratio of liver parenchyma to portal vein on hepatobiliary phase (HBP) acquired at 20 min, and it was compared between normal and cirrhotic livers. The correlation between LPC and hepatic function parameters at HBP after injection was quantitatively analyzed as well. RESULTS LPC differed between normal and cirrhotic livers significantly (P < 0.001). LPC constantly and significantly decreased from normal to cirrhotic livers with Child-Pugh class C at HBP imaging (P < 0.001). Multiple regression analysis revealed that total bilirubin (P = 0.011), albumin (P < 0.001), and platelet count (P = 0.007) were independent predictors of LPC at HBP imaging. A receiver operating characteristic (ROC) curve analysis revealed that the optimal cutoff value for LPC to distinguish normal group from cirrhotic groups was 2.05 (AUC 0.98) with a sensitivity of 84.1% and a specificity of 100%. CONCLUSION The level of LPC on Gd-EOB-DTPA MR imaging can efficaciously indicate the severity of liver function in patients with HBV-related cirrhosis and was correlated with liver function parameters significantly. It might be used as an alternative imaging biomarker for assessing liver function.
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Affiliation(s)
- Weiguo Zhang
- The First Affiliated Hospital of Soochow University, Shizi street No. 188, Suzhou, 215006, Jiangsu, China
| | - Xiao Wang
- The First Affiliated Hospital of Soochow University, Shizi street No. 188, Suzhou, 215006, Jiangsu, China
| | - Youhan Miao
- The First Affiliated Hospital of Soochow University, Shizi street No. 188, Suzhou, 215006, Jiangsu, China
| | - Chunhong Hu
- The First Affiliated Hospital of Soochow University, Shizi street No. 188, Suzhou, 215006, Jiangsu, China
| | - Weifeng Zhao
- The First Affiliated Hospital of Soochow University, Shizi street No. 188, Suzhou, 215006, Jiangsu, China.
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Abstract
Liver fibrosis is a hallmark of chronic liver disease characterized by the excessive accumulation of extracellular matrix proteins. Although liver biopsy is the reference standard for diagnosis and staging of liver fibrosis, it has some limitations, including potential pain, sampling variability, and low patient acceptance. Hence, there has been an effort to develop noninvasive imaging techniques for diagnosis, staging, and monitoring of liver fibrosis. Many quantitative techniques have been implemented on magnetic resonance imaging (MRI) for this indication. The most widely validated technique is magnetic resonance elastography, which aims to measure viscoelastic properties of the liver and relate them to fibrosis stage. Several additional MRI methods have been developed or adapted to liver fibrosis quantification. Diffusion-weighted imaging measures the Brownian motion of water molecules which is restricted by collagen fibers. Texture analysis assesses the changes in the texture of liver parenchyma associated with fibrosis. Perfusion imaging relies on signal intensity and pharmacokinetic models to extract quantitative perfusion parameters. Hepatocellular function, which decreases with increasing fibrosis stage, can be estimated by the uptake of hepatobiliary contrast agents. Strain imaging measures liver deformation in response to physiological motion such as cardiac contraction. T1ρ quantification is an investigational technique, which measures the spin-lattice relaxation time in the rotating frame. This article will review the MRI techniques used in liver fibrosis staging, their advantages and limitations, and diagnostic performance. We will briefly discuss future directions, such as longitudinal monitoring of disease, prediction of portal hypertension, and risk stratification of hepatocellular carcinoma.
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Ippolito D, Inchingolo R, Grazioli L, Drago SG, Nardella M, Gatti M, Faletti R. Recent advances in non-invasive magnetic resonance imaging assessment of hepatocellular carcinoma. World J Gastroenterol 2018; 24:2413-2426. [PMID: 29930464 PMCID: PMC6010944 DOI: 10.3748/wjg.v24.i23.2413] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/27/2018] [Accepted: 05/11/2018] [Indexed: 02/06/2023] Open
Abstract
Magnetic resonance (MR) imaging of the liver is an important tool for the detection and characterization of focal liver lesions and for assessment of diffuse liver disease, having several intrinsic characteristics, represented by high soft tissue contrast, avoidance of ionizing radiation or iodinated contrast media, and more recently, by application of several functional imaging techniques (i.e., diffusion-weighted sequences, hepatobiliary contrast agents, perfusion imaging, magnetic resonance (MR)-elastography, and radiomics analysis). MR functional imaging techniques are extensively used both in routine practice and in the field of clinical and pre-clinical research because, through a qualitative rather than quantitative approach, they can offer valuable information about tumor tissue and tissue architecture, cellular biomarkers related to the hepatocellular functions, or tissue vascularization profiles related to tumor and tissue biology. This kind of approach offers in vivo physiological parameters, capable of evaluating physiological and pathological modifications of tissues, by the analysis of quantitative data that could be used in tumor detection, characterization, treatment selection, and follow-up, in addition to those obtained from standard morphological imaging. In this review we provide an overview of recent advanced techniques in MR for the diagnosis and staging of hepatocellular carcinoma, and their role in the assessment of response treatment evaluation.
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Affiliation(s)
- Davide Ippolito
- School of Medicine, University of Milano-Bicocca, Milan 20126, Italy
- Department of Diagnostic Radiology, HS Gerardo Monza, Monza (MB) 20900, Italy
| | - Riccardo Inchingolo
- Division of Interventional Radiology, Department of Radiology, Madonna delle Grazie Hospital, Matera 75100, Italy
| | - Luigi Grazioli
- Department of Radiology, University of Brescia “Spedali Civili”, Brescia 25123, Italy
| | - Silvia Girolama Drago
- School of Medicine, University of Milano-Bicocca, Milan 20126, Italy
- Department of Diagnostic Radiology, HS Gerardo Monza, Monza (MB) 20900, Italy
| | - Michele Nardella
- Division of Interventional Radiology, Department of Radiology, Madonna delle Grazie Hospital, Matera 75100, Italy
| | - Marco Gatti
- Department of Surgical Sciences, Radiology Unit, University of Turin, Turin 10126, Italy
| | - Riccardo Faletti
- Department of Surgical Sciences, Radiology Unit, University of Turin, Turin 10126, Italy
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Hepatobiliary MRI: Signal intensity based assessment of liver function correlated to 13C-Methacetin breath test. Sci Rep 2018; 8:9078. [PMID: 29899400 PMCID: PMC5998051 DOI: 10.1038/s41598-018-27401-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 06/01/2018] [Indexed: 12/11/2022] Open
Abstract
Gadoxetic acid (Gd-EOB-DTPA) is a paramagnetic MRI contrast agent with raising popularity and has been used for evaluation of imaging-based liver function in recent years. In order to verify whether liver function as determined by real-time breath analysis using the intravenous administration of 13C-methacetin can be estimated quantitatively from Gd-EOB-DTPA-enhanced MRI using signal intensity (SI) values. 110 patients underwent Gd-EOB-DTPA-enhanced 3-T MRI and, for the evaluation of liver function, a 13C-methacetin breath test (13C-MBT). SI values from before (SIpre) and 20 min after (SIpost) contrast media injection were acquired by T1-weighted volume-interpolated breath-hold examination (VIBE) sequences with fat suppression. The relative enhancement (RE) between the plain and contrast-enhanced SI values was calculated and evaluated in a correlation analysis of 13C-MBT values to SIpost and RE to obtain a SI-based estimation of 13C-MBT values. The simple regression model showed a log-linear correlation of 13C-MBT values with SIpost and RE (p < 0.001). Stratified by 3 different categories of 13C-MBT readouts, there was a constant significant decrease in both SIpost (p ≤ 0.002) and RE (p ≤ 0.033) with increasing liver disease progression as assessed by the 13C-MBT. Liver function as determined using real-time 13C-methacetin breath analysis can be estimated quantitatively from Gd-EOB-DTPA-enhanced MRI using SI-based indices.
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Besa C, Wagner M, Lo G, Gordic S, Chatterji M, Kennedy P, Stueck A, Thung S, Babb J, Smith A, Taouli B. Detection of liver fibrosis using qualitative and quantitative MR elastography compared to liver surface nodularity measurement, gadoxetic acid uptake, and serum markers. J Magn Reson Imaging 2018; 47:1552-1561. [PMID: 29193508 DOI: 10.1002/jmri.25911] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/13/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (mpMRI) combining different techniques such as MR elastography (MRE) has emerged as a noninvasive approach to diagnose and stage liver fibrosis with high accuracy allowing for anatomical and functional information. PURPOSE To assess the diagnostic performance of mpMRI including qualitative and quantitative assessment of MRE, liver surface nodularity (LSN) measurement, hepatic enhancement ratios postgadoxetic acid, and serum markers (APRI, FIB-4) for the detection of liver fibrosis. STUDY TYPE IRB-approved retrospective. SUBJECTS Eighty-three adult patients. FIELD STRENGTH/SEQUENCE 1.5T and 3.0T MR systems. MRE and T1 -weighted postgadoxetic acid sequences. ASSESSMENT Two independent observers analyzed qualitative color-coded MRE maps on a scale of 0-3. Regions of interest were drawn to measure liver stiffness on MRE stiffness maps and on pre- and postcontrast T1 -weighted images to measure hepatic enhancement ratios. Software was used to generate LSN measurements. Histopathology was used as the reference standard for diagnosis of liver fibrosis in all patients. STATISTICAL TESTS A multivariable logistic analysis was performed to identify independent predictors of liver fibrosis. Receiver operating characteristic (ROC) analysis evaluated the performance of each imaging technique for detection of fibrosis, in comparison with serum markers. RESULTS Liver stiffness measured with MRE provided the strongest correlation with histopathologic fibrosis stage (r = 0.74, P < 0.001), and the highest diagnostic performance for detection of stages F2-F4, F3-F4, and F4 (areas under the curve [AUCs] of 0.87, 0.91, and 0.89, respectively, P < 0.001) compared to other methods. Qualitative assessment of MRE maps showed fair to good accuracy for detection of fibrosis (AUC range 0.76-0.84). Multivariable logistic analysis identified liver stiffness and FIB-4 as independent predictors of fibrosis with AUCs of 0.90 (F2-F4), 0.93 (F3-F4) and 0.92 (F4) when combined. DATA CONCLUSION Liver stiffness measured with MRE showed the best performance for detection of liver fibrosis compared to LSN and gadoxetic acid uptake, with slight improvement when combined with FIB-4. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1552-1561.
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Affiliation(s)
- Cecilia Besa
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mathilde Wagner
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Grace Lo
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sonja Gordic
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Manjil Chatterji
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Paul Kennedy
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ashley Stueck
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Swan Thung
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - James Babb
- Department of Radiology, New York University Langone Medical Center, New York, New York, USA
| | - Andrew Smith
- Department of Radiology, University of Alabama, Birmingham, Alabama, USA
| | - Bachir Taouli
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Pan S, Wang XQ, Guo QY. Quantitative assessment of hepatic fibrosis in chronic hepatitis B and C: T1 mapping on Gd-EOB-DTPA-enhanced liver magnetic resonance imaging. World J Gastroenterol 2018; 24:2024-2035. [PMID: 29760545 PMCID: PMC5949715 DOI: 10.3748/wjg.v24.i18.2024] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/06/2018] [Accepted: 04/15/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the accuracy of Look-Locker on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) for staging liver fibrosis in chronic hepatitis B/C (CHB/C).
METHODS We prospectively included 109 patients with CHB or CHC who underwent a 3.0-Tesla MRI examination, including T1-weighted and Look-Locker sequences for T1 mapping. Hepatocyte fractions (HeF) and relaxation time reduction rate (RE) were measured for staging liver fibrosis. A receiver operating characteristic analysis using the area under the receiver operating characteristic curve (AUC) was used to compare the diagnostic performance in predicting liver fibrosis between HeF and RE.
RESULTS A total of 73 patients had both pathological results and MRI information. The number of patients in each fibrosis stage was evaluated semiquantitatively according to the METAVIR scoring system: F0, n = 23 (31.5%); F1, n = 19 (26.0%); F2, n = 13 (17.8%); F3, n = 6 (8.2%), and F4, n = 12 (16.4%). HeF by EOB enhancement imaging was significantly correlated with fibrosis stage (r = -0.808, P < 0.05). AUC values for diagnosis of any (≥ F1), significant (≥ F2) or advanced (≥ F3) fibrosis, and cirrhosis (F4) using HeF were 0.837 (0.733-0.913), 0.890 (0.795-0.951), 0.957 (0.881-0.990), and 0.957 (0.882-0.991), respectively. HeF measurement was more accurate than use of RE in establishing liver fibrosis staging, suggesting that calculation of HeF is a superior noninvasive liver fibrosis staging method.
CONCLUSION A T1 mapping-based HeF method is an efficient diagnostic tool for the staging of liver fibrosis.
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Affiliation(s)
- Shen Pan
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Xiao-Qi Wang
- Department of Clinical Science, Philips Healthcare, Beijing 100600, China
| | - Qi-Yong Guo
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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46
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Detecting liver fibrosis with Gd-EOB-DTPA-enhanced MRI: A confirmatory study. Sci Rep 2018; 8:6207. [PMID: 29670136 PMCID: PMC5906481 DOI: 10.1038/s41598-018-24316-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 03/26/2018] [Indexed: 02/06/2023] Open
Abstract
Strong correlations between the grade of fibrosis and cirrhosis, classified using the Ishak scoring system, and the uptake characteristics of Gd-EOB-DTPA with the relative enhancement (RE) of the liver parenchyma have been reported. To confirm the results of a retrospective analysis, patients undergoing liver surgery were prospectively examined with Gd-EOB-DTPA-enhanced liver 3 Tesla MRI to determine the degree of liver fibrosis. Correlations between the grade of fibrosis and cirrhosis, classified using the Ishak scoring system, and RE were investigated and compared with those derived from an initial retrospective study. After validating the cut-off values in the retrospective study (Ishak ≥ 1, RE-cut-off 0.90; Ishak ≥ 2, RE-cut-off 0.79; Ishak ≥ 4, RE-cut-off 0.60; and Ishak = 6, RE-cut-off 0.47), we showed that Gd-EOB-DTPA has a high sensitivity (≥86%) and a high positive predictive value (≥86%). These results support the use of Gd-EOB-DTPA-enhanced liver MRI as a non-invasive method for determining the degree of liver fibrosis and cirrhosis.
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47
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Verloh N, Utpatel K, Haimerl M, Zeman F, Fellner C, Dahlke M, Renner P, Seyfried T, Müller M, Stroszczynski C, Evert M, Wiggermann P. DWI - histology: a possible means of determining degree of liver fibrosis? Oncotarget 2018; 9:20112-20118. [PMID: 29732007 PMCID: PMC5929450 DOI: 10.18632/oncotarget.24981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 03/12/2018] [Indexed: 01/05/2023] Open
Abstract
Objectives The aim of this study was to determine the diagnostic value of diffusion-weighted MRI of the liver at 3T to classify liver fibrosis/cirrhosis. Methods 62 patients who underwent both histopathological examination and diffusion-weighted imaging of the liver via 3T MRI within a period of 3 months were included in the study. The Ishak score (1-6) was used to determine the degree of fibrosis: No liver fibrosis (NLF; Ishak 0, n = 16), mild liver fibrosis (MLF; Ishak 1-2, n = 23), advanced liver fibrosis (ALF; Ishak 3-5, n = 12), and liver cirrhosis (LC; Ishak 6, n = 11). Results The corresponding ADC values for the individual patient groups were as follows: NLF: 1123 (SD 95.8); MLF: 1032 (SD 77.6); ALF: 962 (SD 68.8); LC: 1015 (SD 60.2) mm2/s. There is a significant difference between NLF and MLF (p = 0.004) and between MLF and ALF (p = 0.022). A significant difference between patients with ALF and LC (p = 0.117) could not be found. Conclusion Liver fibrosis/cirrhosis lowers the ADC values of the liver parenchyma in 3T MRI. However, the degree of fibrosis can only be conditionally determined on the basis of ADC values.
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Affiliation(s)
- Niklas Verloh
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Kirsten Utpatel
- Department of Pathology, University Regensburg, Regensburg, Germany
| | - Michael Haimerl
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Trials, University Hospital Regensburg, Regensburg, Germany
| | - Claudia Fellner
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Marc Dahlke
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Philipp Renner
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Timo Seyfried
- Department of Anaesthesia, University Hospital Regensburg, Regensburg, Germany
| | - Martina Müller
- Department of Gastroenterology, University Hospital Regensburg, Regensburg, Germany
| | | | - Matthias Evert
- Department of Pathology, University Regensburg, Regensburg, Germany
| | - Philipp Wiggermann
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
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48
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Borusewicz P, Stańczyk E, Kubiak K, Spużak J, Glińska-Suchocka K, Jankowski M, Nicpoń J, Podgórski P. Liver enhancement in healthy dogs after gadoxetic acid administration during dynamic contrast-enhanced magnetic resonance imaging. Vet J 2018; 235:16-21. [PMID: 29704934 DOI: 10.1016/j.tvjl.2018.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 03/05/2018] [Accepted: 03/11/2018] [Indexed: 12/23/2022]
Abstract
Dynamic contrast enhanced (DCE)-magnetic resonance imaging (MRI) consists of acquisition of native baseline images, followed by a series of acquisitions performed during and after administration of a contrast medium. DCE-MRI, in conjunction with hepatobiliary-specific contrast media, such as gadoxetic acid (GD-EOB-DTPA), allows for precise characterisation of the enhancement pattern of the hepatic parenchyma following administration of the contrast agent. The aim of the study was to assess the pattern of temporal resolution contrast enhancement of the hepatic parenchyma following administration of GD-EOB-DTPA and to determine the optimal time window for post-contrast assessment of the liver. The study was carried out on eight healthy beagle dogs. MRI was performed using a 1.5T scanner. The imaging protocol included T1 weighted (T1-W) gradient echo (GRE), T2 weighted (T2-W) turbo spin echo (TSE) and dynamic T1-W GRE sequences. The dynamic T1-W sequence was performed using single 10mm thick slices. Regions of interest (ROIs) were chosen and the signal intensity curves were calculated for quantitative image analysis. The mean time to peak for all dogs was 26min. The plateau phase lasted on average 21min. A gradual decrease in the signal intensity of the hepatic parenchyma was observed in all dogs. A DCE-MRI enhancement pattern of the hepatic parenchyma was evident in dogs following the administration of a GD-EOB-DTPA, establishing baseline data for an optimal time window between 26 and 41min after administration of the contrast agent.
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Affiliation(s)
- P Borusewicz
- Department of Internal Medicine and Clinic of Diseases of Horses, Dogs and Cats, Faculty of Veterinary Medicine, University of Environmental and Life Sciences, Wroclaw, Poland.
| | - E Stańczyk
- Centre of Experimental Diagnostics and Innovative Biomedical Technology, Faculty of Veterinary Medicine, University of Environmental and Life Sciences, Wroclaw, Poland; Clinic of Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Switzerland
| | - K Kubiak
- Department of Internal Medicine and Clinic of Diseases of Horses, Dogs and Cats, Faculty of Veterinary Medicine, University of Environmental and Life Sciences, Wroclaw, Poland
| | - J Spużak
- Department of Internal Medicine and Clinic of Diseases of Horses, Dogs and Cats, Faculty of Veterinary Medicine, University of Environmental and Life Sciences, Wroclaw, Poland
| | - K Glińska-Suchocka
- Department of Internal Medicine and Clinic of Diseases of Horses, Dogs and Cats, Faculty of Veterinary Medicine, University of Environmental and Life Sciences, Wroclaw, Poland
| | - M Jankowski
- Department of Internal Medicine and Clinic of Diseases of Horses, Dogs and Cats, Faculty of Veterinary Medicine, University of Environmental and Life Sciences, Wroclaw, Poland
| | - J Nicpoń
- Centre of Experimental Diagnostics and Innovative Biomedical Technology, Faculty of Veterinary Medicine, University of Environmental and Life Sciences, Wroclaw, Poland
| | - P Podgórski
- Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Poland
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49
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Affiliation(s)
- Michelle T Long
- From the Section of Gastroenterology, Boston Medical Center (M.T.L.) and Evans Department of Medicine, Whitaker Cardiovascular Institute and Cardiology Section (E.J.B.), Boston University School of Medicine, MA; and Department of Epidemiology (E.J.B.) and Boston Medical Center (E.J.B.), Boston University School of Public Health, MA.
| | - Emelia J Benjamin
- From the Section of Gastroenterology, Boston Medical Center (M.T.L.) and Evans Department of Medicine, Whitaker Cardiovascular Institute and Cardiology Section (E.J.B.), Boston University School of Medicine, MA; and Department of Epidemiology (E.J.B.) and Boston Medical Center (E.J.B.), Boston University School of Public Health, MA
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50
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Xiao YD, Ma C, Liu J, Li HB, Zhou SK, Zhang ZS. Transient severe motion during arterial phase in patients with Gadoxetic acid administration: Can a five hepatic arterial subphases technique mitigate the artifact? Exp Ther Med 2018; 15:3133-3139. [PMID: 29456716 DOI: 10.3892/etm.2018.5760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 01/04/2018] [Indexed: 12/16/2022] Open
Abstract
Gadoxetic acid (Gd-EOB-DTPA) is a hepatocyte-specific magnetic resonance (MR) contrast agent, which has been increasingly used in recent years. However, it has been reported that Gd-EOB-DTPA related transient severe motion (TSM) is sometimes observed during the hepatic arterial phase of MR imaging, which may influence image quality. Since the hepatic arterial phase of contrast enhancement is used for the diagnosis of hepatocellular carcinoma, it is crucial to obtain a decent arterial phase imaging. The present study analyzed motion in patients receiving Gd-EOB-DTPA, comparing a single arterial phase acquisition to a five arterial phase acquisition to determine whether the multiphase acquisition was able to alleviate the TSM-related hepatic arterial MR imaging artifact. It was demonstrated that the single-phase acquisition failed to provide adequate diagnostic image quality in patients with TSM, whereas the multiphase arterial acquisition provided acceptable image quality in 20/22 (90.9%) patients with TSM. In conclusion, the results of the present study demonstrated that multiphase arterial acquisition is superior to single-phase arterial acquisition, mitigating arterial MR imaging artifacts caused by TSM after the administration of Gd-EOB-DTPA.
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Affiliation(s)
- Yu-Dong Xiao
- Department of Radiology, The Second XiangYa Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Cong Ma
- Department of Radiology, The Second XiangYa Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Jun Liu
- Department of Radiology, The Second XiangYa Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Hua-Bing Li
- Department of Radiology, The Second XiangYa Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Shun-Ke Zhou
- Department of Radiology, The Second XiangYa Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Zi-Shu Zhang
- Department of Radiology, The Second XiangYa Hospital of Central South University, Changsha, Hunan 410011, P.R. China
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