Multiparametric magnetic resonance for the non-invasive diagnosis of liver disease

Abstract

Background & AimsWith the increasing prevalence of liver disease worldwide, there is an urgent clinical need for reliable methods to diagnose and stage liver pathology. Liver biopsy, the current gold standard, is invasive and limited by sampling and observer dependent variability. In this study, we aimed to assess the diagnostic accuracy of a novel magnetic resonance protocol for liver tissue characterisation.MethodsWe conducted a prospective study comparing our magnetic resonance technique against liver biopsy. The individual components of the scanning protocol were T1 mapping, proton spectroscopy and T2⁎ mapping, which quantified liver fibrosis, steatosis and haemosiderosis, respectively. Unselected adult patients referred for liver biopsy as part of their routine care were recruited. Scans performed prior to liver biopsy were analysed by physicians blinded to the histology results. The associations between magnetic resonance and histology variables were assessed. Receiver-operating characteristic analyses were also carried out.ResultsPaired magnetic resonance and biopsy data were obtained in 79 patients. Magnetic resonance measures correlated strongly with histology (rs = 0.68 p <0.0001 for fibrosis; rs = 0.89 p <0.001 for steatosis; rs = −0.69 p <0.0001 for haemosiderosis). The area under the receiver operating characteristic curve was 0.94, 0.93, and 0.94 for the diagnosis of any degree of fibrosis, steatosis and haemosiderosis respectively.ConclusionThe novel scanning method described here provides high diagnostic accuracy for the assessment of liver fibrosis, steatosis and haemosiderosis and could potentially replace liver biopsy for many indications. This is the first demonstration of a non-invasive test to differentiate early stages of fibrosis from normal liver.

Influence of fat on liver T1 measurements using modified Look–Locker inversion recovery (MOLLI) methods at 3T

“…Variation of simulated MOLLI T 1 with off‐resonance frequency and using repetition times described in the literature 3, 13…”

“…These curves were obtained by running the simulation for T 1 values corresponding to different disease states as described by Banerjee et al3 (see their fig. 2).…”

“…Since liver MOLLI T 1 values lie in the 700–1400 msec interval,3 five samples over the recovery curve were used for determining the T 1 .…”

“…THE MODIFIED LOOK–LOCKER INVERSION RECOVERY (MOLLI)1 T 1 mapping technique and variants of it have been gaining interest in cardiovascular magnetic resonance imaging (MRI)2 and in liver imaging 3. MOLLI is able to build a T 1 map within a breath‐hold.…”

“…MOLLI is able to build a T 1 map within a breath‐hold. It has also been demonstrated that MOLLI T 1 maps provide diagnostic information in the heart4 and correlate with liver fibrosis and inflammation 3…”