MRE analysis showed no significant difference between the 2 freehand ROI techniques. With a 9% average kPa variance, stiffness measurements for MSDI and MMDI were also not significantly different. The use of the confidence mask reduces calculated stiffness variability, which impacts the use of MRE for assessing therapy response and initial/longitudinal assessment of chronic liver disease.
Our analysis supports previous findings that MRE is a non-invasive and effective method for detection and assessment of liver fibrosis, particularly for discrimination between F0-2 stages and F3-4 stages. MRE may represent a valuable tool to finely discern hepatic fibrosis non-invasively.
Computed tomographic (CT) enterography is a diagnostic examination that is increasingly being used to evaluate disorders of the small bowel. An undesirable consequence of CT, however, is patient exposure to ionizing radiation. This is of particular concern with CT enterography because patients tend to be young and require numerous follow-up examinations. There are multiple strategies to reduce radiation dose at CT enterography, including adjusting acquisition parameters, reducing scan length, and reducing tube voltage or tube current. The drawback to dose reduction strategies is degradation of image quality due to increased image noise. However, image noise can be reduced with commercial iterative reconstruction and denoising techniques. With a combination of low-dose techniques and noise-control strategies, one can markedly reduce radiation dose at CT enterography while maintaining diagnostic accuracy.
Liver stiffness measured by MRE, even in the absence of liver fibrosis, can be useful in differentiating normal from abnormal liver histology, and most importantly in patients under evaluation for live liver donation, can very accurately distinguish those with complicated hepatic steatosis ≥20%, our cutoff for donation. In the future, MRE might provide supplementary information to make liver biopsy unnecessary in the donor evaluation process.
Often compared to the practice of manual palpation, magnetic resonance elastography is an emerging technology for quantitatively assessing the mechanical properties of tissue as a basis for characterizing disease. The potential of MRE as a diagnostic tool is rooted in the fact that normal and diseased tissues often differ significantly in terms of their intrinsic mechanical properties. MRE uses magnetic resonance imaging (MRI) in conjunction with the application of mechanical shear waves to probe tissue mechanics. This process can be broken down into three essential steps: 1. inducing shear waves in the tissue, 2. imaging the propagating shear waves with MRI, and 3. analyzing the wave data to generate quantitative images of tissue stiffness MRE has emerged as a safe, reliable and noninvasive method for staging hepatic liver fibrosis, and is now used in some locations as an alternative to biopsy. MRE is also being used in the ongoing investigations of numerous other organs and tissues, including, for example, the spleen, kidney, pancreas, brain, heart, breast, skeletal muscle, prostate, vasculature, lung, spinal cord, eye, bone, and cartilage. In the article that follows, some fundamental techniques and applications of MRE are summarized.
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