Comparison of interobserver agreement of magnetic resonance elastography with histopathological staging of liver fibrosis

Runge, Jurgen H.; Bohte, Anneloes E.; Verheij, Joanne; Terpstra, Valeska; Nederveen, Aart J.; Nieuwkerk, Karin M.J. van; Knegt, R.J. de; Baak, Bert C.; Jansen, Petér L. M.; Sinkus, Ralph; Stoker, Jaap

doi:10.1007/s00261-013-0063-z

Cited by 43 publications

(31 citation statements)

References 24 publications

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“…With a 3.0-T Philips system, similarly excellent repeatability has been shown by using a 2D GRE sequence, with a bias of just 0.21 kPa between repeated measures of liver stiffness acquired in the same patients on the same day (25). It is interesting that the greatest test-retest repeatability observed in our study was liver stiffness as an imaging surrogate for parenchymal fibrosis (1,3,22,23). For this diagnostic test to gain wide acceptance, reliability of results must be demonstrated.…”

Section: Overall and Subpopulation Agreementsupporting

confidence: 56%

Liver Stiffness Measurements with MR Elastography: Agreement and Repeatability across Imaging Systems, Field Strengths, and Pulse Sequences

Trout¹,

Serai²,

Mahley³

et al. 2016

Radiology

108

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Purpose To prospectively assess agreement and repeatability of magnetic resonance (MR) elastography liver stiffness measurements across imager manufacturers, field strengths, and pulse sequences. Materials and Methods This prospective cross-sectional study was approved by the institutional review board; informed consent was obtained from all subjects. On the basis of an a priori power calculation, 24 volunteer adult subjects underwent MR elastography with four MR imaging systems (two vendors) and multiple pulse sequences (two-dimensional [2D] gradient-echo [GRE] imaging, 2D spin-echo [SE] echo-planar imaging, and three-dimensional [3D] SE echo-planar imaging). Each sequence was performed twice in each patient with each imaging system. Intraclass correlation coefficients (ICCs) were used to assess agreement and repeatability. P < .05 was considered indicative of a statistically significant difference. Results Pairwise ICCs were 0.67-0.82 and 0.62-0.83 for agreement between pulse sequences across manufacturers (n = 4) and field strengths (n = 5), respectively. ICCs were 0.45-0.90 for pairwise agreement between sequences while fixing manufacturer and field strength (n = 8). Test-retest repeatability across the various manufacturer, field strength, and pulse sequence combinations (n = 10) was excellent (ICCs, 0.77-0.94). The overall ICC for all manufacturer, field strength, and sequence combinations (n = 10) was 0.68 (95% confidence interval [CI]: 0.55, 0.82). ICC according to field strength was 0.78 (95% CI: 0.67, 0.88) at 1.5 T (n = 5) and 0.64 (95% CI: 0.49, 0.78) at 3.0 T (n = 5). ICCs according to vendor were 0.83 (95% CI: 0.73, 0.91) (n = 4) and 0.65 (95% CI: 0.51, 0.79) (n = 6). Average patient level variance was 0.042 kPa, with a coefficient of variation of 10.7%. Conclusion MR elastography is a reliable method for assessing liver stiffness, with small amounts of variability between imager manufacturers, field strengths, and pulse sequences. RSNA, 2016.

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Section: Overall and Subpopulation Agreementsupporting

confidence: 56%

Liver Stiffness Measurements with MR Elastography: Agreement and Repeatability across Imaging Systems, Field Strengths, and Pulse Sequences

Trout¹,

Serai²,

Mahley³

et al. 2016

Radiology

108

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“…94 The inter-observer agreement in assessments for MRE has been demonstrated to be high (ICC 0.99, 95% CI 0.98 – 1.00), and the agreement for MRE assessments is higher than that with pathologist staging (ICC 0.91, 95% CI 0.86 – 0.94). 95 Thus, MRE is highly accurate for detecting hepatic fibrosis, results are not influenced by patient demographics making assessments reproducible across key sub-populations, and the inter-observer agreement for staging fibrosis is nearly perfect and higher than that seen with histopathology. For these reasons, MRE is considered to be a reliable, highly accurate, and precise method for assessing hepatic fibrosis.…”

Section: Mre Based Assessment Of Hepatic Fibrosismentioning

confidence: 99%

MRI and MRE for non-invasive quantitative assessment of hepatic steatosis and fibrosis in NAFLD and NASH: Clinical trials to clinical practice

Dulai

Sirlin

Loomba

2016

Journal of Hepatology

289

262

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Nonalcoholic fatty liver disease (NAFLD) represents one of the most common causes of chronic liver disease, and its prevalence is rising worldwide. The occurrence of nonalcoholic steatohepatitis (NASH) is associated with a substantial increase in disease related morbidity and mortality. Accordingly, there has been a surge of innovation surrounding drug development in an effort to off-set the natural progression and long-term risks of this disease. Disease assessment within clinical trials and clinical practice for NAFLD is currently done with liver biopsies. Liver biopsy-based assessments, however, remain imprecise and are not without cost or risk. This carries significant implications for the feasibility and costs of bringing therapeutic interventions to market. A need therefore arises for reliable and highly accurate surrogate end-points that can be used in phase 2 and 3 clinical trials to reduce trial size requirements and costs, while improving feasibility and ease of implementation in clinical practice. Significant advances have now been made in magnetic resonance technology, and magnetic resonance imaging (MRI) and elastrography (MRE) have been demonstrated to be highly accurate diagnostic tools for the detection of hepatic steatosis and fibrosis. In this review article, we will summarize the currently available evidence regarding the use of MRI and MRE among NAFLD patients, and the evolving role these surrogate biomarkers will play in the rapidly advancing arena of clinical trials in NASH and hepatic fibrosis. Furthermore, we will highlight how these tools can be readily applied to routine clinical practice, where the growing burden of NAFLD will need to be met with enhanced monitoring algorithms.

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“…By inversion of the wave image data, Hookean viscoelastic mechanical properties, such as the shear storage modulus G d , can be quantified [47,48]. In liver diseases MRE proves to be a technique of great diagnostic and etiologic value [49–52], and is also increasingly utilized for use in the kidney, spleen, brain, breast, heart, lungs, prostate, and skeletal muscle [53–61]. MRE studies of skeletal muscle have primarily focused on healthy skeletal muscle to better understand the complex anisotropic viscoelastic mechanical properties and to assess changes in muscle shear stiffness during active and passive contraction [62–70].…”

Section: Introductionmentioning

confidence: 99%

A MRI-Compatible Combined Mechanical Loading and MR Elastography Setup to Study Deformation-Induced Skeletal Muscle Damage in Rats

et al. 2017

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Deformation of skeletal muscle in the proximity of bony structures may lead to deep tissue injury category of pressure ulcers. Changes in mechanical properties have been proposed as a risk factor in the development of deep tissue injury and may be useful as a diagnostic tool for early detection. MRE allows for the estimation of mechanical properties of soft tissue through analysis of shear wave data. The shear waves originate from vibrations induced by an external actuator placed on the tissue surface. In this study a combined Magnetic Resonance (MR) compatible indentation and MR Elastography (MRE) setup is presented to study mechanical properties associated with deep tissue injury in rats. The proposed setup allows for MRE investigations combined with damage-inducing large strain indentation of the Tibialis Anterior muscle in the rat hind leg inside a small animal MR scanner. An alginate cast allowed proper fixation of the animal leg with anatomical perfect fit, provided boundary condition information for FEA and provided good susceptibility matching. MR Elastography data could be recorded for the Tibialis Anterior muscle prior to, during, and after indentation. A decaying shear wave with an average amplitude of approximately 2 μm propagated in the whole muscle. MRE elastograms representing local tissue shear storage modulus Gd showed significant increased mean values due to damage-inducing indentation (from 4.2 ± 0.1 kPa before to 5.1 ± 0.6 kPa after, p<0.05). The proposed setup enables controlled deformation under MRI-guidance, monitoring of the wound development by MRI, and quantification of tissue mechanical properties by MRE. We expect that improved knowledge of changes in soft tissue mechanical properties due to deep tissue injury, will provide new insights in the etiology of deep tissue injuries, skeletal muscle damage and other related muscle pathologies.

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Comparison of interobserver agreement of magnetic resonance elastography with histopathological staging of liver fibrosis

Abstract: Interobserver agreement for liver fibrosis staging was almost perfect for both histopathology and MRE, with a significant higher agreement for MRE. Its high interobserver agreement and reliable accuracy support the use of MRE as a non-invasive screening tool for liver fibrosis.

Cited by 43 publications

References 24 publications

Liver Stiffness Measurements with MR Elastography: Agreement and Repeatability across Imaging Systems, Field Strengths, and Pulse Sequences

Liver Stiffness Measurements with MR Elastography: Agreement and Repeatability across Imaging Systems, Field Strengths, and Pulse Sequences

MRI and MRE for non-invasive quantitative assessment of hepatic steatosis and fibrosis in NAFLD and NASH: Clinical trials to clinical practice

A MRI-Compatible Combined Mechanical Loading and MR Elastography Setup to Study Deformation-Induced Skeletal Muscle Damage in Rats

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