Combined Use of MR Fat Quantification and MR Elastography in Living Liver Donors: Can It Reduce the Need for Preoperative Liver Biopsy?

Yoon, Jeong Hee; Lee, Jeong Min; Suh, Kyung‐Suk; Lee, Kwan-Woong; Yi, Nam Joon; Lee, Kyuho; Han, Joon Koo; Choi, Byung Ihn

doi:10.1148/radiol.15140908

Cited by 46 publications

(58 citation statements)

References 48 publications

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“…Hwang et al reported high sensitivity and specificity with the use of MRS and triple‐echo Dixon for the detection of substantial (≥10%) hepatic steatosis among donors. Yoon et al using a multiecho iterative decomposition of water and fat with echo asymmetry and least‐squares estimation (IDEAL) MRI sequence reported very high NPVs of up to 98% to exclude substantial (also defined as ≥ 10%) hepatic steatosis among donors. Interestingly, as noted in our study, they reported low PPVs with MRI for the detection of hepatic steatosis.…”

Section: Discussionmentioning

confidence: 99%

Can negligible hepatic steatosis determined by magnetic resonance imaging–proton density fat fraction obviate the need for liver biopsy in potential liver donors?

et al. 2018

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The purpose of this study is to determine whether magnetic resonance (MR)-proton density fat fraction (PDFF) estimate of negligible hepatic fat percentage (<5%) can exclude significant hepatic steatosis (≥10%) in living liver donor candidates obviating the need for liver biopsy and to perform intraindividual comparisons between MR-PDFF techniques for hepatic steatosis quantification. In an ethics-approved retrospective study, 144 liver donor candidates with magnetic resonance spectroscopy (MRS) and 6-echo Dixon magnetic resonance imaging (MRI) between 2013 and 2015 were included. A subset of 32 candidates underwent liver biopsy. Hepatic fat percentage was determined using MR-PDFF and histopathology-determined fat fraction as the reference standard. A receiver operating characteristic analysis with positive predictive value, negative predictive value (NPV), sensitivity, and specificity was performed to discriminate between clinically significant steatosis (≥10%) or not (<10%) at MRS-PDFF and MRI-PDFF thresholds of 5% and 10%. Pearson correlation and Bland-Altman analyses between MRS-PDFF and MRI-PDFF were performed for intraindividual comparison of hepatic steatosis estimation. There was significant association between MRS-PDFF and MRI-PDFF with HP-FP. High NPV of 95% (95% confidence interval [CI], 78%-99%) and 100% (95% CI, 76%-100%) as well as an area under the curve of 0.90 (95% CI, 0.79-1.0) and 0.93 (95% CI, 0.84-1.0) were obtained with a cutoff threshold of 5% MRI-PDFF and MRS-PDFF, respectively, to exclude clinically significant steatosis (≥10%). Intraindividual comparison between MRS-PDFF and MRI-PDFF showed a Pearson correlation coefficient of 0.83. Bland-Altman analysis showed a mean difference of 1% with 95% limits of agreement between -1% and 3%. MR-PDFF estimate of negligible hepatic fat percentage (<5%) has sufficient NPV for excluding clinically significant hepatic steatosis (≥10%) in living liver donor candidates obviating the need for liver biopsy. It may be sufficient to acquire only the multiecho Dixon MRI-PDFF for hepatic steatosis estimation. Liver Transplantation 24 470-477 2018 AASLD.

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Section: Discussionmentioning

confidence: 99%

Can negligible hepatic steatosis determined by magnetic resonance imaging–proton density fat fraction obviate the need for liver biopsy in potential liver donors?

et al. 2018

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“…15,17 A recent study showed that a combination of MR fat quantification and MR elastography can provide 100% sensitivity and a 100% negative predictive value for the detection of substantial steatosis or fibrosis (≥F1) in liver donor candidates. 15 However, the complexity of these procedures makes them difficult to use in routine organ procurement. The limitations of MRI include variations due to differences between MRI systems, scanning parameters, and methods of analysis.…”

Section: Discussionmentioning

confidence: 99%

“…10–15 Additionally, controlled attenuation parameters (CAP) and liver stiffness measurements (LSMs) based on the properties of US signals acquired by vibration controlled transient elastography (VCTE) have recently been introduced, based on the postulate that fat affects ultrasound propagation. 16 Unfortunately, these tools are limited by cost, restricted availability, operator dependence, and poor sensitivity.…”

Section: Introductionmentioning

confidence: 99%

Predicting Hepatic Steatosis in Living Liver Donors via Noninvasive Methods

Kim

Ha²,

Joh³

et al. 2016

Medicine

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Hepatic steatosis assessment is of paramount importance for living liver donor selection because significant hepatic steatosis can affect the postoperative outcome of recipients and the safety of the donor. The validity of various noninvasive imaging methods to assess hepatic steatosis remains controversial. The purpose of our study is to investigate the association between noninvasive imaging methods and pathology to detect steatosis in living liver donors and to propose a prediction model for hepatic steatosis.Liver stiffness measurements (LSMs) and controlled attenuation parameter values in vibration controlled transient elastography, ultrasonography, computed tomography (CT), and magnetic resonance imaging were used as pretransplant screening methods to evaluate living liver donors between 2012 and 2014. Only 1 pathologist assessed tissue sample for hepatic steatosis.The median age of the 79 living donors (53 men and 26 women) was 32 years (16–68 years). The CT liver–spleen attenuation (L–S) difference and the controlled attenuation parameter values were well correlated with the level of hepatic steatosis on liver pathology. Multivariate analysis showed that liver stiffness measurement (LSM) (β 0.903; 95% CI, 0.105–1.702; P = 0.027) and the CT L to S attenuation difference (β = −3.322; 95% CI, −0.502 to −0.142; P = 0.001) were closely associated with hepatic steatosis. We generated the following equation to predict total hepatic steatosis: Hepatic steatosis = 0.903 × LSM – 0.322 × CT L to S attenuation difference (AUC = 86.6% and P = 0.001). The values predicted by the equation correlated well with the presence of hepatic steatosis (r = 0.509 and P < 0.001).The combination of nonenhanced CT L to S attenuation difference and transient elastography using vibration controlled transient elastography provides sufficient information to predict hepatic steatosis in living liver donor candidates.

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“…M agnetic resonance (MR) elastography is a noninvasive means of assessing hepatic stiffness that has been shown to correlate well with histopathologic grading of fibrosis, potentially obviating biopsy and its attendant risks in some patients (1)(2)(3)(4)(5)(6)(7)(8)(9). Quantitative stiffness images (elastograms) of the liver can be rapidly obtained during breath-hold acquisitions and, therefore, can be readily included in conventional liver MR imaging protocols or obtained as a short dedicated GASTROINTESTINAL IMAGING: Agreement and Repeatability of MR Elastography Trout et al between repeat imaging with the same MR elastography sequence on the same imaging system.…”

Section: Implications For Patient Carementioning

confidence: 99%

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

Trout¹,

Serai²,

Mahley³

et al. 2016

Radiology

109

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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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Combined Use of MR Fat Quantification and MR Elastography in Living Liver Donors: Can It Reduce the Need for Preoperative Liver Biopsy?

Cited by 46 publications

References 48 publications

Can negligible hepatic steatosis determined by magnetic resonance imaging–proton density fat fraction obviate the need for liver biopsy in potential liver donors?

Can negligible hepatic steatosis determined by magnetic resonance imaging–proton density fat fraction obviate the need for liver biopsy in potential liver donors?

Predicting Hepatic Steatosis in Living Liver Donors via Noninvasive Methods

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

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