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

Trout, Andrew T.; Serai, Suraj D.; Mahley, Alana D; Wang, Hui; Zhang, Yue; Zhang, Bin; Dillman, Jonathan R.

doi:10.1148/radiol.2016160209

Cited by 108 publications

(96 citation statements)

References 28 publications

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“…The high interexamination ICC (0.86) observed in our study for this technique is consistent with previously reported results (ICC ~ 0.85 – 0.94; [13,14,17,32]). The other MRE technical variants examined in this study have not been described as extensively in the literature[33]. Our study suggests that most of these variants – including 2D MRE using a flexible driver at end-inspiration, and 3D MRE under any tested condition – are likely to have good repeatability.…”

Section: Discussionmentioning

confidence: 79%

Repeatability and reproducibility of 2D and 3D hepatic MR elastography with rigid and flexible drivers at end-expiration and end-inspiration in healthy volunteers

et al. 2017

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Purpose To evaluate the repeatability and reproducibility of 2D and 3D hepatic MRE with rigid and flexible drivers at end expiration and inspiration in healthy volunteers. Material and Methods Nine healthy volunteers underwent two same-day MRE exams separated by a 5–10 minute break. In each exam, 2D and 3D MRE scans were performed, each under four conditions (2 driver types [rigid, flexible] × 2 breath-hold phases [end-expiration, end-inspiration]). Repeatability (measurements under identical conditions) and reproducibility (measurements under different conditions) were analyzed by calculating bias, limit of agreement, repeatability coefficient (RC), reproducibility coefficient (RDC), intraclass correlation coefficient (ICC), and concordance correlation coefficient (CCC), as appropriate. Results For 2D MRE, RCs and ICCs range between 0.29 – 0.49 and 0.71 – 0.91, respectively. For 3D MRE, RCs and ICCs range between 0.16 – 0.26 and 0.84 – 0.96, respectively. Stiffness values were biased by breath-hold phase, being higher at end-inspiration than end-expiration, and the differences were significant for 3D MRE (p < 0.01). No bias was found between driver types. Inspiration-vs.- expiration RDCs and CCCs ranged between 0.30–0.54 and 0.61–0.72, respectively. Rigid-vs.-flexible driver RDCs and CCCs ranged between 0.10–0.44 and 0.79–0.94, respectively. Conclusion This preliminary study suggests that 2D MRE and 3D MRE under most conditions potentially have good repeatability. Our result also points to the possibility that stiffness measured with the rigid and flexible drivers is reproducible. Reproducibility between breath-hold phases was modest, suggesting breath-hold phase might be a confounding factor in MRE-based stiffness measurement. However, larger studies are required to validate these preliminary results.

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Section: Discussionmentioning

confidence: 79%

Repeatability and reproducibility of 2D and 3D hepatic MR elastography with rigid and flexible drivers at end-expiration and end-inspiration in healthy volunteers

et al. 2017

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“…Finally, 31 studies fulfilled the eligibility criteria for our analysis, including eight studies using both GRE and SE‐EPI sequences, 22 studies using only a GRE sequence, , , , , , , , and one study using only an SE‐EPI sequence . As one study using both GRE and SE‐EPI sequences potentially overlapped with a population in another GRE sequence outcome study, we did not include the outcomes of this study in the evaluation of the pooled proportion of technical failure of GRE sequences, but used it only for the head‐to‐head comparison between GRE and SE‐EPI sequences.…”

Section: Resultsmentioning

confidence: 99%

“…Nonetheless, as people tend to focus more on successful results rather than technical failure when presenting the results of studies, the failure rates of MRE have not been reported well. A limited number of studies have reported on the technical failure rate of MRE, and fewer studies have made comparisons regarding the failure rates between these two sequences. The results from the studies are also limited by their small sample sizes and the resulting low levels of evidence.…”

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confidence: 99%

Comparison of technical failure of MR elastography for measuring liver stiffness between gradient‐recalled echo and spin‐echo echo‐planar imaging: A systematic review and meta‐analysis

Kim

Yoon

et al. 2019

Magnetic Resonance Imaging

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Background Magnetic resonance elastography (MRE) using a gradient‐recalled echo (GRE) or a recently available spin‐echo echo‐planar imaging (SE‐EPI) sequence is a promising noninvasive method for measuring liver stiffness. However, it sometimes fails to measure stiffness values, thereby resulting in technical failures. Purpose To assess and compare technical failures of MRE for measuring liver stiffness between GRE and SE‐EPI sequences. Study Type Systematic review and meta‐analysis. Population Eight studies with both GRE and SE‐EPI, 22 studies with only GRE, one study with only SE‐EPI. Field Strength/Sequence Either 1.5 or 3T MRE using GRE and/or SE‐EPI. Assessment Through an Ovid‐MEDLINE and EMBASE database search, original articles investigating the proportion of MRE technical failures in the measurement of liver stiffness published up until October 2018 were screened and selected. Statistical Analysis The pooled proportions of technical failures under GRE and SE‐EPI were calculated using random‐effects meta‐analysis of single proportions and inverse variance for calculating weights. Subgroup analyses were performed to explore the covariates affecting heterogeneity. Head‐to‐head comparisons of technical failure between the sequences were conducted with eight MRE studies using both GRE and SE‐EPI. Results The pooled proportion of technical failure under GRE MRE was 5.8% (95% confidence interval [CI], 4.6–7.4%), and a subgroup analysis showed higher technical failure rates at 3T than at 1.5T. The pooled proportion of technical failure under SE‐EPI MRE was 2.0% (95% CI, 1.3–3.4%), without significant differences (P = 0.38–0.89) being observed in the subgroup analyses. In the eight studies comparing the two sequences, failure was more frequently observed with GRE than with SE‐EPI (9.4% vs. 1.9%; P < 0.01). Data Conclusion MRE conducted with SE‐EPI sequences showed a lower technical failure rate than GRE sequences. With GRE sequences, a magnetic field of 3T was associated with higher technical failure rates than was 1.5T. Level of Evidence: 1 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2020;51:1086–1102.

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“…Another limitation is that we kept the imaging matrix unchanged within a wide field of view range to maintain reasonable scan time in our pig model. However, this effect could have been counted in several repeatability and reproducibility studies (34-36). However, a systematic evaluation is still needed.…”

Section: Discussionmentioning

confidence: 99%

Distinguishing between Hepatic Inflammation and Fibrosis with MR Elastography

et al. 2017

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Purpose To investigate the utility of Magnetic Resonance Elastography (MRE)-derived mechanical properties in discriminating hepatic inflammation and fibrosis in the early stages of chronic liver diseases. Material and Methods All studies were approved by our institutional animal care and use committee. A total of 187 animals were studied, including 182 mice and 5 pigs that represent five different liver diseases with a varying combination and extent of hepatic inflammation, fibrosis, congestion and portal hypertension. We performed multifrequency 3-D MRE with shear stiffness, storage and loss modulus, and damping ratio calculated in all animal subjects. Necroinflammation, fibrosis, and portal pressure were either histologically scored or bio-chemically/physically quantified in all studied animals. Two-sided Welch's t-tests were used to evaluate the mean differences between diseased and control/sham groups. Spearman's correlation analyses were used to evaluate the relationships between the mechanical parameters and the quantitative fibrosis extent (hydroxyproline concentration) and portal pressure. Results Liver shear stiffness and storage modulus increased with progressively developed fibrosis and portal hypertension (stiffness @80Hz, 48-week-feeding, steatohepatitis/controls, 0.51±0.12/0.29±0.01kPa, p=0.02). Damping ratio and loss modulus can distinguish inflammation from fibrosis at early stages, even before the development of histologically detectable necroinflammation and fibrosis (damping ratio @80Hz, 20-week-feeding, steatohepatitis/controls, 0.044±0.012 vs. 0.014±0.008, p<0.001). Damping ratio and shear stiffness vary differently with respect to etiology of portal hypertension (i.e., congestion or cirrhosis induced). These differentiation abilities have frequency-dependent variations. Conclusion Liver stiffness and damping ratio measurements can extend hepatic MRE to potentially assess necroinflammatory, congestive, and fibrotic processes of chronic liver diseases.

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

Cited by 108 publications

References 28 publications

Repeatability and reproducibility of 2D and 3D hepatic MR elastography with rigid and flexible drivers at end-expiration and end-inspiration in healthy volunteers

Repeatability and reproducibility of 2D and 3D hepatic MR elastography with rigid and flexible drivers at end-expiration and end-inspiration in healthy volunteers

Comparison of technical failure of MR elastography for measuring liver stiffness between gradient‐recalled echo and spin‐echo echo‐planar imaging: A systematic review and meta‐analysis

Distinguishing between Hepatic Inflammation and Fibrosis with MR Elastography

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