Multiparametric magnetic resonance imaging predicts clinical outcomes in patients with chronic liver disease

Pavlides, Michael; Banerjee, Rajarshi; Sellwood, Joanne; Kelly, Catherine; Robson, Matthew D; Booth, J; Collier, Jane; Neubauer, Stefan; Barnes, Eleanor

doi:10.1016/j.jhep.2015.10.009

Cited by 181 publications

(190 citation statements)

References 37 publications

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“…However, there is no natural history study of liver-related outcomes in a low-risk population that can be used as a comparison. cT1 values have been shown to predict clinical outcomes in chronic liver disease patients [9]. The whole UK Biobank cohort will be censured at 3 yearly intervals to collect clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Acquisition was performed in end-expiration breath-hold and without the aid of any contrast agent injection. This slice-based methodology has previously been shown to correlate well with histology [8] and predict liver-related outcomes [9]. The rapid acquisition time (£ 3 min) was an essential requirement to meet the high-throughput demands of the UK Biobank study [14].…”

Section: Imaging Protocolmentioning

confidence: 99%

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Reference range of liver corrected T1 values in a population at low risk for fatty liver disease—a UK Biobank sub-study, with an appendix of interesting cases

et al. 2018

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Purpose: Corrected T1 (cT1) value is a novel MRI-based quantitative metric for assessing a composite of liver inflammation and fibrosis. It has been shown to distinguish between non-alcoholic fatty liver disease (NAFL) and non-alcoholic steatohepatitis. However, these studies were conducted in patients at high risk for liver disease. This study establishes the normal reference range of cT1 values for a large UK population, and assesses interactions of age and gender. Methods: MR data were acquired on a 1.5 T system as part of the UK Biobank Imaging Enhancement study. Measures for Proton Density Fat Fraction and cT1 were calculated from the MRI data using a multiparametric MRI software application. Data that did not meet quality criteria were excluded from further analysis. Inter and intra-reader variability was estimated in a set of data. A cohort at low risk for NAFL was identified by excluding individuals with BMI ‡ 25 kg/m 2 and PDFF ‡ 5%. Of the 2816 participants with data of suitable quality, 1037 (37%) were classified as at low risk. Results:The cT1 values in the low-risk population ranged from 573 to 852 ms with a median of 666 ms and interquartile range from 643 to 694 ms. Iron correction of T1 was necessary in 36.5% of this reference population. Age and gender had minimal effect on cT1 values. Conclusion:The majority of cT1 values are tightly clustered in a population at low risk for NAFL, suggesting it has the potential to serve as a new quantitative imaging biomarker for studies of liver health and disease.

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Section: Discussionmentioning

confidence: 99%

Section: Imaging Protocolmentioning

confidence: 99%

Reference range of liver corrected T1 values in a population at low risk for fatty liver disease—a UK Biobank sub-study, with an appendix of interesting cases

et al. 2018

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“…To overcome these limitations, standardized quantitative MR biomarkers have been introduced, including proton density fat fraction (PDFF) for liver fat, T2* for iron, and stiffness for fibrosis. With the availability of multi-parametric quantitative MRI for hepatic fat, iron, and fibrosis, one-stop virtual liver biopsy has now become a clinical reality [93–97]. While these noninvasive biomarkers do not obviate the need for liver biopsy, it may help avoid unnecessary biopsies by screening prior to invasive testing, or acting as a surrogate biomarker.…”

Section: Resultsmentioning

confidence: 99%

Quantitative Imaging Biomarkers of NAFLD

2016

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Conventional imaging modalities, including ultrasonography (US), computed tomography (CT), and magnetic resonance (MR), play an important role in the diagnosis and management of patients with nonalcoholic fatty liver disease (NAFLD) by allowing noninvasive diagnosis of hepatic steatosis. However, conventional imaging modalities are limited as biomarkers of NAFLD for various reasons. Multi-parametric quantitative MRI techniques overcome many of the shortcomings of conventional imaging and allow comprehensive and objective evaluation of NAFLD. MRI can provide unconfounded biomarkers of hepatic fat, iron, and fibrosis in a single examination—a virtual biopsy has become a clinical reality. In this article, we will review the utility and limitation of conventional US, CT, and MR imaging for the diagnosis NAFLD. Recent advances in imaging biomarkers of NAFLD are also discussed with an emphasis in multi-parametric quantitative MRI.

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“…T1 values need to be adjusted for the hepatic iron level, because iron accumulation in the presence of fibrosis can mimic normal T1 values. This method has demonstrated a good correlation with histological stage of liver fibrosis and it seems promising in predicting negative clinical outcomes in patients with chronic liver disease [58].…”

Section: Mr Quantification Of Hepatic Fibrosismentioning

confidence: 99%

Liver MRI: From basic protocol to advanced techniques

Donato

França

Candelária

et al. 2017

European Journal of Radiology

107

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A B S T R A C TLiver MR is a well-established modality with multiparametric capabilities. However, to take advantage of its full capacity, it is mandatory to master the technique and optimize imaging protocols, apply advanced imaging concepts and understand the use of different contrast media. Physiologic artefacts although inherent to upper abdominal studies can be minimized using triggering techniques and new strategies for motion control. For standardization, the liver MR protocol should include motion-resistant T2-w sequences, in-op phase GRE T1 and T2-w fast spin echo sequences with fat suppression. Diffusion-weighted imaging (DWI) is mandatory, especially for detection of sub-centimetre metastases. Contrast-enhanced MR is the cornerstone of liver MR, especially for lesion characterization. Although extracellular agents are the most extensively used contrast agents, hepatobiliary contrast media can provide an extra-layer of functional diagnostic information adding to the diagnostic value of liver MR. The use of high field strength (3T) increases SNR but is more challenging especially concerning artefact control. Quantitative MR belongs to the new and evolving field of radiomics where the use of emerging biomarkers such as perfusion or DWI can derive new information regarding disease detection, prognostication and evaluation of tumour response. This information can overcome some of the limitations of current tests, especially when using vascular disruptive agents for oncologic treatment assessment. MR is, today, a robust, mature, multiparametric imaging modality where clinical applications have greatly expanded from morphology to advanced imaging. This new concept should be acknowledged by all those involved in producing high quality, high-end liver MR studies.

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Multiparametric magnetic resonance imaging predicts clinical outcomes in patients with chronic liver disease

Abstract: Graphical abstract

Cited by 181 publications

References 37 publications

Reference range of liver corrected T1 values in a population at low risk for fatty liver disease—a UK Biobank sub-study, with an appendix of interesting cases

Reference range of liver corrected T1 values in a population at low risk for fatty liver disease—a UK Biobank sub-study, with an appendix of interesting cases

Quantitative Imaging Biomarkers of NAFLD

Liver MRI: From basic protocol to advanced techniques

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