Stiffness change of the supraspinatus muscle can be detected by magnetic resonance elastography

Magnetic resonance elastography (MRE) and ultrasound shear wave elastography (SWE) are imaging techniques to measure stiffness of the soft tissue using magnetic resonance imaging (MRI) and ultrasound images, respectively. The purpose of this study was to explore the feasibility of the MRE measurement to evaluate the change in supraspinatus (SSP) muscle stiffness before and after rotator cuff tear, and to compare the result with those of SWE. Six swine shoulders were used. The skin and subcutaneous fat were removed, and the stiffness value of the SSP muscle was measured by MRE and SWE. The MRE measurement was performed with 0.3 T open MRI and the vibration from a pneumatic driver system with active driver to a passive driver to create the shear wave in the tissue. The passive driver was placed on the center of the SSP muscle. The stiffness was estimated from the wave images using local frequency estimation methods. In the SWE measurement, the probe of the ultrasound was placed on the center of the SSP muscle. The shear wave propagation speed was measured at a depth of 1 cm from the surface, and the stiffness was calculated. After those measurements, the rotator cuff tendon was detached from the greater tuberosity, and MRE and SWE measurements were then performed in the same manner again. The differences in the stiffness values were compared between before and after the rotator cuff tendon tear on both the MRE and SWE measurements. The results indicated that stiffness values on MRE and SWE were 9.3 ± 1.8 and 10.0 ± 1.2 kPa respectively before the rotator cuff tear, and 7.3 ± 1.3 and 8.0 ± 0.8 kPa respectively after the tendon detachment. Stiffness values were significantly lower after the tendon detachment on both the MRE and SWE measurements (p < 0.05). Our results demonstrated that stiffness values of the SSP muscle on MRE and SWE were lower after rotator cuff detachment. From this result, MRE may be a feasible method for quantification of the change in rotator cuff muscle stiffness.     

Rapid acquisition technique for MR elastography of the liver

Magnetic resonance elastography (MRE) of the liver is a novel noninvasive clinical diagnostic tool to stage fibrosis based on measured stiffness. The purpose of this study is to design, evaluate and validate a rapid MRE acquisition technique for noninvasively quantitating liver stiffness which reduces by half the scan time, thereby decreasing image registration errors between four MRE phase offsets. In vivo liver MRE was performed on 16 healthy volunteers and 14 patients with biopsy-proven liver fibrosis using the standard clinical gradient recalled echo (GRE) MRE sequence (MREs) and a developed rapid GRE MRE sequence (MREr) to obtain the mean stiffness in an axial slice. The mean stiffness values obtained from the entire group using MREs and MREr were 2.72 ± 0.85 kPa and 2.7 ± 0.85 kPa, respectively, representing an insignificant difference. A linear correlation of R² = 0.99 was determined between stiffness values obtained using MREs and MREr. Therefore, we can conclude that MREr can replace MREs, which reduces the scan time to half of that of the current standard acquisition (MREs), which will facilitate MRE imaging in patients with inability to hold their breath for long periods.     

Potential clinical factors affecting hepatobiliary enhancement at Gd-EOB-DTPA-enhanced MR imaging

Objective

The objective was to clarify the clinical factors that might affect the degree of hepatic parenchymal enhancement at gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) imaging.

Materials and Methods

A total of 84 patients with (n=63) and without chronic liver disease (n=21) underwent Gd-EOB-DTPA-enhanced MR imaging. Contrast-enhanced MR images of hepatobiliary phase (HP) were obtained at 20 min after Gd-EOB-DTPA administration. The relative enhancement (RE) of liver parenchyma at 20 min HP was calculated from region of interest measurements at each patient. Then, these results were correlated with various clinical parameters using Pearson correlation coefficient or Spearman rank correlation coefficient. Furthermore, the predictor of the degree of hepatic parenchymal enhancement was determined using multiple regression analysis.

Results

The presence or absence of chronic liver disease (P=.002), ascites (P=.005) and splenomegaly (P=.027), and the values of prothrombin activity (P=.008), total bilirubin (T-Bil) (P=.001), albumin (P=.001), aspartate aminotransferase (AST) (P=.002) and cholinesterase (P=.007) were significantly correlated with the RE of liver parenchyma at 20 min HP. Among these parameters, increases of T-Bil (P=.011 to .028) and AST (P=.018 to .049) were predictors of decreased hepatic parenchymal enhancement.

Conclusions

Hepatic parenchymal enhancement of Gd-EOB-DTPA was affected by various clinical parameters. Impaired hepatobiliary enhancement may be predicted by routine biochemical tests, such as T-Bil and AST.     

Effect of hepatic steatosis on native T1 mapping of 3T magnetic resonance imaging in the assessment of T1 values for patients with non-alcoholic fatty liver disease

PurposeThis study investigated whether T1 values in native T1 mapping of 3T magnetic resonance imaging (MRI) of the liver were affected by the fatty component.MethodsThis prospective study involved 340 participants from a population-based cohort study between May 8, 2018 and August 8, 2019. Data obtained included: (1) hepatic stiffness according to magnetic resonance elastography (MRE); (2) T1 value according to T1 mapping; (3) fat fraction and iron concentration from multi-echo Dixon; and (4) clinical indices of hepatic steatosis including body mass index, waist circumference, history of diabetes, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transpeptidase, and triglycerides. The correlations between T1 value and fat fraction, and between T1 value and liver stiffness were assessed using Pearson's correlation coefficient. The independent two-sample t-test was used to evaluate the differences in T1 values according to the presence or absence of hepatic steatosis, and the one-way analysis of variance was used to evaluate the difference in T1 value by grading of hepatic steatosis according to MRI-based proton density fat fraction (PDFF). In addition, univariate and multivariate linear regression analyses were performed to determine whether other variables influenced the T1 value.ResultsT1 value showed a positive correlation with the fat fraction obtained from PDFF (r = 0.615, P < 0.001) and with the liver stiffness obtained from MRE (r = 0.370, P < 0.001). Regardless of the evaluation method, the T1 value was significantly increased in subjects with hepatic steatosis (P < 0.001). When comparing hepatic steatosis grades based on MRI-PDFF, the mean T1 values were significantly different in all grades, and the T1 value tended to increase as the grade increased (P < 0.001, P for trend <0.001). On multiple linear regression analysis, the T1 value was influenced by MRI-PDFF, calculated liver iron concentration, liver stiffness, and serum aspartate aminotransferase level.ConclusionThe T1 value obtained by current T1 mapping of 3T MRI was affected by the liver fat component and several other factors such as liver stiffness, iron concentration, and inflammation.     

Quantitative MRI of the liver: Evaluation of extracellular volume fraction and other quantitative parameters in comparison to MR elastography for the assessment of hepatopathy

BackgroundChronic liver diseases pose a major health problem worldwide, while common tests for diagnosis and monitoring of diffuse hepatopathy have considerable limitations. Preliminary data on the quantification of hepatic extracellular volume fraction (ECV) with magnetic resonance imaging (MRI) for non-invasive assessment of liver fibrosis are encouraging, with ECV having the potential to overcome several of these constraints.PurposeTo clinically evaluate ECV provided by quantitative MRI for assessing the severity of liver disease.Materials and methodsIn this prospective study, multiparametric liver MRI, including T1 mapping and magnetic resonance elastography (MRE), was performed in subjects with and without hepatopathy between November 2018 and October 2019. T1, T2, T2*, proton density fat fraction and stiffness were extracted from parametric maps by regions of interest and ECV was calculated from T1 relaxometries. Serum markers of liver disease were obtained by clinical database research. For correlation analysis, Spearman rank correlation was used. ROC analysis of serum markers and quantitative MRI data for discrimination of liver cirrhosis was performed with MRE as reference standard.Results109 participants were enrolled (50.7 ± 16.1 years, 61 men). ECV, T1 and MRE correlated significantly with almost all serum markers of liver disease, with ECV showing the strongest associations (up to r = 0.67 with MELD, p < 0.01). ECV and T1 correlated with MRE (0.75 and 0.73, p < 0.01 each). ECV (AUC 0.89, cutoff 32.2%, sensitivity 85%, specificity 87%) and T1 mapping (AUC 0.85, cutoff 592.5 ms, sensitivity 83%, specificity 75%) featured good performances in detection of liver cirrhosis with only ECV performing significantly superior to model of end stage liver disease (MELD), AST/ALT ratio and international normalized ratio (p < 0.01, respectively).ConclusionQuantification of hepatic extracellular volume fraction with MRI is suitable for estimating the severity of liver disease when using MRE as the standard of reference. It represents a promising tool for non-invasive assessment of liver fibrosis and cirrhosis.     

Effect of Gd-EOB-DTPA on hepatic fat quantification using high-speed T2-corrected multi-echo acquisition in H MR spectroscopy

Purpose

To determine whether gadolinium ethoxybenzyldiethylenetriaminepentaacetic acid (Gd-EOB-DTPA) administration affects hepatic fat quantification by magnetic resonance spectroscopy (MRS) using the fast breath-hold high-speed T2-corrected multiecho (HISTO) technique.

Materials and Methods

Seventy-six patients underwent Gd-EOB-DTPA-enhanced liver MR and 15 sec breath-hold HISTO MRS (4 times), twice before and twice after Gd-EOB-DTPA administration. Two consecutive MRSs were performed immediately before the dynamic study. Post-contrast MRS was performed twice continuously, approximately 15 min after contrast injection, prior to obtaining 20-min hepatobiliary phase images. We used paired t-test and intraclass correlation coefficient (ICC) to evaluate the variability of the mean fat fraction (FF) on pre-contrast MRS and post-contrast MRS and the effect of the contrast agent on the mean FF.

Results

The mean FFs were not significantly different between pre-contrast MRS and post-contrast MRS (6.50% ± 6.54 versus 6.70% ± 6.61, P = 0.15). The ICC of FF calculation between pre- and post-contrast MRS was 0.984. The ICCs for the FF magnitude between pre- and post-contrast MRS were 0.452, 0.771, and 0.995 for FF < 5%, FF 5–10%, and FF ≥ 10%, respectively.

Conclusion

Gd-EOB-DTPA does not appear to influence hepatic fat quantification, especially for patients with hepatic steatosis.     

Finite element analysis to investigate variability of MR elastography in the human thigh

Purpose: To develop finite element analysis (FEA) of magnetic resonance elastography (MRE) in the human thigh and investigate inter-individual variability of measurement of muscle mechanical properties.Methods: Segmentation was performed on MRI datasets of the human thigh from 5 individuals and FEA models consisting of 12 muscles and surrounding tissue created. The same material properties were applied to each tissue type and a previously developed transient FEA method of simulating MRE using Abaqus was performed at 4 frequencies. Synthetic noise was applied to the simulated data at various levels before inversion was performed using the Elastography Software Pipeline. Maps of material properties were created and visually assessed to determine key features. The coefficient of variation (CoV) was used to assess the variability of measurements in each individual muscle and in the groups of muscles across the subjects. Mean measurements for the set of muscles were ranked in size order and compared with the expected ranking.Results: At noise levels of 2% the CoV in measurements of |G^*| ranged from 5.3 to 21.9% and from 7.1 to 36.1% for measurements of ϕ in the individual muscles. A positive correlation (R² value 0.80) was attained when the expected and measured |G^*| ranking were compared, whilst a negative correlation (R² value 0.43) was found for ϕ.Conclusions: Created elastograms demonstrated good definition of muscle structure and were robust to noise. Variability of measurements across the 5 subjects was dramatically lower for |G^*| than it was for ϕ. This large variability in ϕ measurements was attributed to artefacts.     

MRI findings in nonalcoholic steatohepatitis: correlation with histopathology and clinical staging

Purpose

To evaluate magnetic resonance imaging (MRI) findings of nonalcoholic steatohepatitis (NASH) and to determine the correlation of MRI findings with histopathology and Mayo End-Stage Liver Disease (MELD) score.

Materials and Methods

Thirty patients (18 males, 12 females; mean age: 57±8.9 years; age range: 35–71 years) with histopathologically proven NASH who underwent MRI examinations between January 2001 and October 2005 were included in the study. Two radiologists retrospectively reviewed all magnetic resonance (MR) examinations in consensus to evaluate the presence and extent of predetermined findings of NASH including liver steatosis, early patchy liver enhancement indicating inflammation and liver fibrosis. The findings detected on MRI were correlated and compared to histopathological findings and MELD score by using nonparametric Spearman correlation coefficient and Kruskal–Wallis analysis of variance.

Results

Liver steatosis was observed in 10 of 30 patients; early patchy liver enhancement, in 8 of 30 patients and liver fibrosis in 19 of 30 patients on MR images. Liver fibrosis was reticular in all these patients. There were statistically significant moderate correlations between MRI findings of liver steatosis and histopathologic grades of steatosis (r=0.43; P<.05), and between MRI findings of fibrosis and histopathologic stages of fibrosis (r=0.61; P<.001). Early patchy enhancement did not demonstrate statistically significant correlation with inflammation (P=.28). There was no statistically significant overall correlation between MRI findings of NASH and MELD score.

Conclusion

MRI findings of liver steatosis and fibrosis in NASH showed moderate correlations with histopathologic grades of steatosis and stages of fibrosis, but MRI findings of NASH did not demonstrate any significant correlations with MELD score.     

Comparison of breath-hold,respiratory navigated and free-breathing MR elastography of the liver

PurposeHepatic magnetic resonance elastography (MRE) is currently a breath-hold imaging technique. Patients with chronic liver disease can have comorbidities that limit their ability to breath-hold (BH) for the required acquisition time. Our aim was to evaluate whether stiffness measurements obtained from a navigator-triggered MRE acquisition are comparable to standard expiratory breath-hold, inspiratory breath-hold or free-breathing in healthy participants.Materials and methodsTwelve healthy participants were imaged using the four methods on a clinical 1.5 T MR system equipped with a product MRE system. Mean liver stiffness, and measurable area of stiffness (with a confidence threshold >95%) were compared between sequences using the concordance correlation coefficient. Repeatability of each sequence between two acquisitions was also assessed.ResultsThe standard BH expiratory technique had high concordance with the navigated technique (r = 0.716), and low concordance with the BH inspiration (r = 0.165) and free-breathing (r = 0.105) techniques. The navigator-triggered technique showed no statistical difference in measurable area of liver or in repeatability compared with the standard expiratory acquisition (p = 0.997 and p = 0.407 respectively). The free-breathing technique produced less measurable liver area and was less repeatable than the alternative techniques. The increase in acquisition time for navigator techniques was 3 min 6 s compared to standard expiratory breath-hold.ConclusionNavigator-based hepatic MRE measurements are comparable to the reference standard expiratory breath-hold acquisition in healthy participants.     

Magnetic resonance elastography of the pancreas: Measurement reproducibility and relationship with age

PurposeTo determine magnetic resonance elastography (MRE)-derived stiffness of pancreas in healthy volunteers with emphasis on: 1) short term and midterm repeatability; and 2) variance as a function of age.MethodsPancreatic MRE was performed on 22 healthy volunteers (age range:20–64 years) in a 3 T–scanner. For evaluation of reproducibility of stiffness estimates, the scans were repeated per volunteer on the same day (short term) and one month apart (midterm). MRE wave images were analyzed using 3D inversion to estimate the stiffness of overall pancreas and different anatomic regions (i.e., head, neck, body, and tail). Concordance and Spearman correlation tests were performed to determine reproducibility of stiffness measurements and relationship to age.ResultsA strong concordance correlation (ρ_c = 0.99; p-value < 0.001) was found between short term and midterm repeatability pancreatic stiffness measurements. Additionally, the pancreatic stiffness significantly increased with age with good Spearman correlation coefficient (all ρ > 0.81; p < 0.001). The older age group (> 45 yrs) had significantly higher stiffness compared to the younger group (≤ 45 yrs) (p < 0.001). No significant difference (p > 0.05) in stiffness measurements was observed between different anatomical regions of pancreas, except neck stiffness was slightly lower (p < 0.012) compared to head and overall pancreas at month 1.ConclusionMRE-derived pancreatic stiffness measurements are highly reproducible in the short and midterm and increase linearly with age in healthy volunteers. Further studies are needed to examine these effects in patients with various pancreatic diseases to understand potential clinical applications.     

Assessment of the link between quantitative biexponential diffusion-weighted imaging and contrast-enhanced MRI in the liver

PurposeTo investigate if intravoxel incoherent motion (IVIM) modeled diffusion-weighted imaging (DWI) can be linked to contrast-enhanced (CE-)MRI in liver parenchyma and liver lesions.MethodsTwenty-five patients underwent IVIM-DWI followed by multiphase CE-MRI using Gd-EOB-DTPA (n = 20) or Gd-DOTA (n = 5) concluded with IVIM-DWI. Diffusion (D_slow), microperfusion (D_fast), its fraction (f_fast), wash-in-rate (R_early) and late-enhancement-rate (R_late) of Gd-EOB-DTPA were calculated voxel-wise for the liver. Parenchyma and lesions were segmented. Pre-contrast IVIM was compared 1) between low, medium and high R_early for parenchyma 2) to post-contrast IVIM substantiated with simulations 3) between low and high R_late per lesion type.ResultsD_fast and f_fast increased (P < 0.001) with 25.6% and 33.8% between low and high R_early of Gd-EOB-DTPA. D_slow decreased (− 15.0%; P < 0.001) with increasing R_early. Gd-DOTA demonstrated similar observations. f_fast (+ 10%; P < 0.001) and D_fast (+ 6.6%; P < 0.001) increased after Gd-EOB-DTPA, while decreasing after Gd-DOTA (− 4.2% and − 5.7%, P < 0.001) and were confirmed by simulations. For focal nodular hyperplasia lesions (n = 5) D_fast and f_fast increased (P < 0.001) with increasing R_late, whereas for hepatocellular carcinoma (n = 4) and adenoma (n = 7) no differences were found.ConclusionMicroperfusion measured by IVIM reflects perfusion in a way resembling CE-MRI. Also IVIM separated intra- and extracellular MR contrast media. This underlines the potential of IVIM in quantitative liver imaging.     

Can preoperative diffusion-weighted MRI predict postoperative hepatic insufficiency after curative resection of HBV-related hepatocellular carcinoma? A pilot study

Liver fibrosis determines the functional liver reserve. Several studies have reported that the apparent diffusion coefficient (ADC) values of diffusion-weighted magnetic resonance imaging (DW-MRI) can assess liver fibrosis. We investigated whether DW-MRI predicts postoperative hepatic insufficiency and liver fibrosis in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). Twenty-six patients with HBV-related HCC who received preoperative DW-MRI on a 3-T MRI system were enrolled between July and December 2008. ADC values were measured twice by two observers. Three “b values” were used: 50, 400 and 800 s/mm². Postoperative hepatic insufficiency was defined as persistent hyperbilirubinemia (total bilirubin level >5 mg/dl for more than 5 days after surgery) or postoperative death without other causes. The mean age (21 men and 5 women) was 51.4 years. Three patients experienced postoperative hepatic insufficiency. liver stiffness measurement predicted postoperative hepatic insufficiency, advanced fibrosis (F3–4), and cirrhosis significantly [area under the receiving operator characteristic curve (AUROC)=0.942, 0.771 and 0.818, respectively, with P=.047, 0.048 and 0.006, respectively]; ADC values of DW-MRI, however, did not (AUROC=0.797, 0.648 and 0.491, respectively, with P=.100, 0.313 and 0.938, respectively). Reliability of ADC values between right and left hepatic lobes (ρ=0.868 and ρ=0.910 in the first and second measures of Observer A; ρ=0.865 and ρ=0.831 in the first and second measures of Observer B) was high and the intra- and interobserver reliability (ρ=0.958 in observer A and ρ=0.977 in observer B; ρ=0.929 in the first measure and ρ=0.978 in the second measure between the two observers) were high. All reliability was significant (P<.001). Our results suggest that DW-MRI on a 3-T MRI system is not suitable for predicting postoperative hepatic insufficiency, advanced liver fibrosis, and cirrhosis in patients with HBV-related HCC, despite significantly high reliability.     

Evaluation of gadoxetate disodium as a contrast agent for mouse liver imaging: comparison with gadobenate dimeglumine

We investigated the characteristics of gadoxetate disodium (Gd-EOB-DTPA) as a contrast agent for magnetic resonance imaging of the mouse liver. Mice were imaged sequentially under isoflurane anesthesia using a T1-weighted, three-dimensional fast low-angle shot (3D FLASH) sequence after an intravenous injection of Gd-EOB-DTPA or gadobenate dimeglumine (Gd-BOPTA), and the time course of the contrast effect was examined. The time course of the contrast effect of Gd-EOB-DTPA was also assessed after intravenous injection under pentobarbital anesthesia and after subcutaneous injection while awake or under isoflurane or pentobarbital anesthesia. Moreover, different doses of Gd-EOB-DTPA or Gd-BOPTA were injected subcutaneously into conscious mice, and the clarity of the liver border was evaluated visually. Intravenous injection under isoflurane anesthesia caused rapid contrast enhancement in the liver with both Gd-EOB-DTPA and Gd-BOPTA, and the contrast effect was 41% stronger with Gd-EOB-DTPA. Subcutaneous injection of Gd-EOB-DTPA caused delayed but favorable contrast enhancement in the liver. Washout of Gd-EOB-DTPA was faster in mice injected while awake than in those injected under anesthesia. After intravenous injection, washout was faster under pentobarbital anesthesia than under isoflurane anesthesia. The peak liver contrast was 11% and 18% stronger under pentobarbital anesthesia than under isoflurane anesthesia, after intravenous and subcutaneous injections, respectively. Subcutaneous injection of Gd-EOB-DTPA or Gd-BOPTA caused dose-dependent contrast effects in the liver. At a given dose, the contrast effect tended to be stronger and liver demarcation tended to be clearer with Gd-EOB-DTPA than with Gd-BOPTA. In conclusion, intravenous or subcutaneous injection of Gd-EOB-DTPA produces a favorable contrast effects in the mouse liver, indicating its potential in investigating mouse models of liver diseases. The contrast effects vary between conscious mice and anesthetized mice and among anesthetic agents used.     

MR elastography of hepatocellular carcinoma: Correlation of tumor stiffness with histopathology features—Preliminary findings

PurposeTo determine if tumor stiffness by MR Elastography (MRE) is associated with hepatocellular carcinoma (HCC) pathologic features.Material and methodsA retrospective review was undertaken of all patients with pathologically confirmed HCC who underwent MRE prior to loco-regional therapy, surgical resection or transplant between 1/1/2007 to 12/31/2015. An independent observer measured tumor stiffness (kilopascals, kPa) by drawing regions of interest (ROI) covering the HCC and in the case of HCCs with non-enhancing/necrotic components, only the solid portion was included in the ROI. HCC tumor grade (WHO criteria), vascular invasion and tumor encapsulation were assessed from retrievable pathology specimens by an expert hepatobiliary pathologist. Tumor stiffness was compared by tumor grade, size, presence of capsule and vascular invasion using Student's t-test (or Exact Mann-Whitney test).Results21 patients were identified who had pathologically confirmed HCCs and tumor MRE data. 17 patients (81.0%) had underlying chronic liver disease. The mean ± SD tumor size (cm) was 5.3 ± 3.9 cm. The mean ± SD tumor stiffness was 5.9 ± 1.4 kPa. Tumors were graded as well differentiated (N = 2), moderately differentiated (N = 11) and poorly differentiated (N = 8). There was a trend toward increased tumor stiffness in well/moderately differentiated HCCs (6.5 ± 1.2 kPa; N = 13) compared to poorly differentiated HCCs (4.9 ± 1.2 kPa; N = 8) (p < 0.01). There was no significant correlation between tumor stiffness and liver stiffness or tumor size. There was no significant difference in tumor stiffness by presence or etiology of chronic liver disease, vascular invasion or tumor encapsulation.ConclusionPreliminary data suggest that tumor stiffness by MRE may be able to differentiate HCC tumor grade.     

Assessment of stiffness changes in the ex vivo porcine aortic wall using magnetic resonance elastography

Magnetic resonance elastography (MRE) is a noninvasive phase-contrast technique for estimating the mechanical properties of tissues by imaging propagating mechanical waves within the tissue. In this study, we hypothesize that changes in arterial wall stiffness, experimentally induced by formalin fixation, can be measured using MRE in ex vivo porcine aortas. In agreement with our hypothesis, the significant stiffness increase after sample fixation was clearly demonstrated by MRE and confirmed by mechanical testing. The results indicate that MRE can be used to examine the stiffness changes of the aorta. This study has provided evidence of the effectiveness of using MRE to directly assess the stiffness change in aortic wall. The results offer motivation to pursue MRE as a noninvasive method for the evaluation of arterial wall mechanical properties.     

Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced MR finding of radiation-induced hepatic injury: Relationship to absorbed dose and time course after irradiation

Purpose

To evaluate if Gd-EOB-DTPA-enhanced MRI could identify liver tissue damage caused by radiation exposure in patients undergoing external beam radiation therapy.

Materials and methods

We enrolled 11 patients who underwent Gd-EOB-DTPA-enhanced MRI during or after radiotherapy in which the radiation field included the liver. External beam radiotherapy was delivered through multiple fields using a 10-MV linear accelerator. The hepatobiliary phase images of Gd-EOB-DTPA-enhanced MRI were qualitatively evaluated for the presence of a decreased uptake of Gd-EOB-DTPA in the irradiated area in the liver. Next, signal intensity (SI) ratio of the irradiated area to the non-irradiated liver parenchyma was also calculated. The absorbed dose of the irradiated area in the liver was standardized using equivalent dose in 2 Gy fraction (EQD2) and biological effective dose (BED). The results of qualitative analysis were compared with EQD2 or BED, and linear regression analysis was performed between EQD2 or BED and SI ratio.

Results

Twenty-two irradiated areas were evaluated. Qualitative analysis revealed a decreased uptake of Gd-EOB-DTPA in 14 areas and no decreased uptake of Gd-EOB-DTPA in eight areas. The thresholds of EQD2 and BED causing a decreased uptake of Gd-EOB-DTPA were considered to be 24 to 29 Gy and 29 to 35 Gy, respectively. Quantitatively, SI ratio decreased as EQD2 or BED increased (r = 0.89, p < 0.001), and the inverse relationship between signal enhancement and the absorbed dose in the irradiated area was obtained. One area with EQD2 of 50 Gy and BED of 60Gy showed a slightly decreased uptake of Gd-EOB-DTPA on the 40th day but a clearly decreased uptake of Gd-EOB-DTPA on the 123rd day from initiation of radiotherapy.

Conclusions

Gd-EOB-DTPA-enhanced MRI described RLI as a decreased uptake of Gd-EOB-DTPA matching the irradiated area. The occurrence of this finding was significantly correlated with the absorbed dose of the irradiated area in the liver.     

Dynamic contrast-enhanced MRI with Gd-EOB-DTPA for the quantitative assessment of early-stage liver fibrosis induced by carbon tetrachloride in rabbits

PurposeTo explore quantitative parameters obtained by dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) with Gd-EOB-DTPA in discriminating early-stage liver fibrosis (LF) in a rabbit model.Materials and methodsLF was established in 60 rabbits by the injection of 50% CCl₄ oil solution, whereas 30 rabbits served as the control group. All rabbits underwent pathological examination to determine the LF stage using the METAVIR classification system. DCE MRI was performed, and quantitative parameters, including K^trans, K_ep, V_e, V_p and Re were measured and evaluated among the different LF stages using spearman correlation coefficients and receiver operating characteristic curve.ResultsIn all, 24, 25, and 22 rabbits had stage F0, stage F1, and stage F2 LF, respectively. K^trans (r = 0.803) increased, and K_ep (r = −0.495) and Re (r = −0.701) decreased with LF stage progression (P < 0.001), while no significant correlation was found for V_e or V_p. K^trans and Re were significantly different between all LF stage pairs compared (F0 vs. F1, F0 vs. F2, F1 vs. F2, F0 vs. F1-F2, P < 0.05). With the exception of F0 vs. F1, K_ep differed significantly between stages (P < 0.05). The AUC of K^trans was higher than that of other quantitative parameters, with an AUC of 0.92, 0.99, 0.94 and 0.92 for staging F0 vs. F1, F0 vs. F2, F1 vs. F2, and F0 vs. F1-F2, respectively.ConclusionAmong quantitative parameters of Gd-EOB-DTPA DCE MRI, K^trans was the best predictor for quantitatively differentiating early-stage LF.     

Paradoxical uptake of Gd-EOB-DTPA on the hepatobiliary phase in the evaluation of hepatic metastasis from breast cancer: is the “target sign” a common finding?

Purpose

The purpose was to describe magnetic resonance imaging (MRI) findings of breast cancer liver metastasis using gadoxetic acid (Gd-EOB-DTPA) with an emphasis on the added value of the hepatobiliary phase (HBP).

Material and methods

Nine patients with 13 liver metastases were included in the study after the medical records of 29 breast cancer patients who underwent Gd-EOB-DTPA-enhanced MRI between February 2008 and June 2010 were reviewed. The diagnoses of liver metastasis were established by percutaneous liver biopsy or surgery and on the basis of image findings. Two radiologists retrospectively evaluated signal intensity (SI) and sizes of metastases and patterns of enhancement in an HBP. The SI ratio was calculated as the SI of the central hyperintense portion in “target” lesions divided by the SI of nearby normal liver parenchyma on the HBP. We also measured apparent diffusion coefficient (ADC) values from Diffusion Weighted Image (DWI).

Results

Liver metastases were all hypointense [n=13/13 (100%)] on T1-weighted imaging (WI), and many lesions had a “target” appearance with a central high SI and a peripheral low SI rim (47%) on T2WI. Dynamic study showed rim enhancement on the arterial phase (85%) and a “target” appearance, consisting of a central enhancing portion with peripheral washout or hypointense rim, on the HBP (62%). The mean SI ratio was 0.7. The mean ADC value of “target” appearing metastases was 1.25 (×10⁻³ mm²/s; range 1.3–1.6) compared with a mean value of 0.8 (×10⁻³ mm²/s; range 0.8–1.4) in homogeneous defect on the HBP. There was statistically significant difference (P<.05).

Conclusion

Breast cancer liver metastases commonly demonstrated as a peripheral ring enhancement on arterial dominant phase and a target sign with a central round enhancing portion and a peripheral hypointense rim on the HBP.     

Feasibility of MR elastography of the intervertebral disc

Low back pain (LBP) is a costly and widely prevalent health disorder in the U.S. One of the most common causes of LBP is degenerative disc disease (DDD). There are many imaging techniques to characterize disc degeneration; however, there is no way to directly assess the material properties of the intervertebral disc (IVD) within the intact spine. Magnetic resonance elastography (MRE) is an MRI-based technique for non-invasively mapping the mechanical properties of tissues in vivo. The purpose of this study was to investigate the feasibility of using MRE to detect shear wave propagation in and determine the shear stiffness of an axial cross-section of an ex vivo baboon IVD, and compare with shear displacements from a finite element model of an IVD motion segment in response to harmonic shear vibration. MRE was performed on two baboon lumbar spine motion segments (L3–L4) with the posterior elements removed at a range of frequencies (1000–1500 Hz) using a standard clinical 1.5 T MR scanner. Propagating waves were visualized in an axial cross-section of the baboon IVDs in all three motion-encoding directions, which resembled wave patterns predicted using finite element modeling. The baboon nucleus pulposus showed an average shear stiffness of 79 ± 15 kPa at 1000 Hz. These results suggest that MRE is capable of visualizing shear wave propagation in the IVD, assessing the stiffness of the nucleus of the IVD, and can differentiate the nucleus and annulus regions.     

Diffusion-weighted imaging (DWI) of the spleen in patients with liver cirrhosis and portal hypertension

Objective

The purpose of this study was to assess the influence of liver cirrhosis and portal hypertension on diffusion coefficients of the spleen.

Material and Methods

We retrospectively evaluated 50 patients with liver cirrhosis and 50 patients without any history of liver disease who underwent magnetic resonance imaging of the upper abdomen, including echo planar diffusion-weighted imaging using b values of 50, 300 and 600 mm²/s. Spleen apparent diffusion coefficient (ADC), liver ADC, muscle ADC and normalized spleen ADC (defined as the ratio of spleen ADC to muscle ADC) were compared between cirrhotic patients and patients in the control group and correlated with Child–Pugh stages. Reproducibility was assessed by measuring interclass correlation coefficient (n = 11). Additionally, in eight patients, ADC measurements were performed 1 day before and 3 days after transjugular intrahepatic portosystemic shunt (TIPSS) implantation.

Results

Compared with control subjects, patients with cirrhosis and portal hypertension had significantly higher spleen ADCs (P = .0001). There was a statistically significant correlation between Child–Pugh grade and spleen ADC (Pearson correlation coefficient, observer 1 r = 0.6, P = .0001; observer 2 r = 0.5, P = .0001). After TIPSS implantation, we observed a reduction in spleen ADC values. Spleen ADC measurements showed a high reproducibility (interclass correlation coefficient 0.75, P = .001).

Conclusion

Our data suggest that different stages of liver cirrhosis and portal hypertension correlate with ADC values of the spleen. Furthermore, ADC values of the spleen decrease after TIPSS implantation. Further studies are required to understand the potential clinical values of these observations.