MRI cine‐tagging of cardiac‐induced motion for noninvasive staging of liver fibrosis

Abstract

Background: MR elastography is a noninvasive technique that provides high diagnostic accuracy for the staging of liver fibrosis; however, it requires external hardware and mainly assesses the right lobe. Purpose: To evaluate the diagnostic performance of MRI cine-tagging for staging fibrosis in the left liver lobe, using biopsy as the reference standard. Study Type: Institutional Review Board (IRB)-approved two-center prospective study. Population: Seventy-six patients with chronic liver disease who underwent an MRI cine-tagging examination and a liver biopsy within a 6-week interval. Field Strength/Sequence: 2D-GRE multislice sequence at 3.0T with spatial modulation of the magnetization preparation sequence and peripheral pulse-wave triggering on two coronal slices chosen underneath the heart apex to capture maximal deformation with consecutive breath-holds adapted to patient cardiac frequency. Assessment: A region of interest was selected in the liver close to the heart apex. Maximal strain was evaluated with the harmonic phase (HARP) technique. Statistical Tests: Spearman's correlation, Kruskal-Wallis test, Mann-Whitney U-test, and receiver operating characteristic (ROC) analysis were performed. Results: Liver strain measured on tagged images decreased with higher histological fibrosis stage (ρ = -0.68, P < 0.0001). Strain values were significantly different between all fibrosis stages (P < 0.0001), and between groups of fibrosis stages ≤F3 vs. F4 (P < 0.05). Areas under the ROC curves were 0.95 (95% confidence interval: 0.89-1.00) to distinguish fibrosis stages F0 vs. F4, 0.81 (0.70-0.92) for stages F0 vs. ≥F1, 0.84 (0.76-0.93) for stages ≤F1 vs. ≥F2, 0.86 (0.78-0.94) for stages ≤F2 vs. ≥F3, and 0.87 (0.77-0.96) for stages ≤F3 vs. F4. Data Conclusion: MRI cine-tagging is a promising technique for measuring liver strain without additional elastography hardware. It could be used to assess the left liver lobe as a complement to current techniques assessing the right lobe.

An off‐resonance insensitive orthogonal CSPAMM sequence (ORI‐O‐CSPAMM) for the acquisition of CSPAMM and MICSR grids in half scan time

“…However, in patients with fatty infiltration of the left ventricle (LV), that is, where the fat is inside the cardiac tissue, sequences such as ORI‐CSPAMM and ORI‐O‐CSPAMM could improve the cardiac motion and related parameters estimations. Moreover, a recent study has demonstrated that the strain estimated from tagged MR images is a valuable marker for staging non‐invasively liver fibrosis in non‐alcoholic fatty liver disease (NAFLD) patients 21 . As the NAFLD stages are an inflammatory process in the presence of fat, we hypothesize that the use of ORI sequences (particularly ORI‐O‐CSPAMM) can be helpful at the early stages of the disease.…”

“…Moreover, a recent study has demonstrated that the strain estimated from tagged MR images is a valuable marker for staging non-invasively liver fibrosis in non-alcoholic fatty liver disease (NAFLD) patients. 21 As the NAFLD stages are an inflammatory process in the presence of fat, we hypothesize that the use of ORI sequences (particularly ORI-O-CSPAMM) can be helpful at the early stages of the disease. Even more, ORI-O-CSPAMM can be used in clinical protocols replacing SPAMM, which would increase the scan time of tagging grids by a factor of two instead of four as it would be done with ORI-CSPAMM.…”

“…Although the CSPAMM sequence provides images that are suitable to assess not only the cardiac function but also to evaluate other organs, 8,21 its use remains limited for clinical applications due to the prolonged scan times. Additionally, images obtained from CSPAMM data can suffer from offresonance effects generated during the tagging preparation.…”

Cine MR feature tracking analysis for diagnosing thymic epithelial tumors: a feasibility study

“…Stiffness of the thymus in healthy children evaluated by MR elastography presented a mild negative correlation with age, height, and weight, which can be influenced by changes in the thymic epithelial space and the perivascular space [ 18 ]. Cine-MR feature tracking analysis can also provide information on tissue stiffness [ 8 , 19 – 21 ], in which tissue deformation is inversely proportional to tissue stiffness. Cardiovascular MR feature tracking to quantify myocardial strain has been reported to be associated with ventricular stiffness [ 19 ], and cardiac-induced deformation using cine-MR tagging analysis has been used to assess liver stiffness [ 20 , 21 ].…”

Procedimientos diagnósticos para enfermedad hepática crónica: más allá del lactante

“…La toma de una biopsia hepática sigue siendo el patrón de referencia para el diagnóstico de cirrosis que, además de estadificar el grado de fibrosis, contribuye a esclarecer su causa. 16,17…”