Potential of Liver T₁ Mapping for the Detection of Fontan-associated Liver Disease in Adults

Abstract

The native T 1 value at 3T MRI is a sensitive marker for diffuse fibrosis or damage in various organs including the heart, liver, and pancreas. Despite the fact that Fontan-associated liver disease (FALD) is a crucial issue in adults with Fontan circulation, there are only a few studies with liver T 1 mapping in children and adolescents. We investigated the potential of the liver native T 1 mapping in detecting FALD in adult patients. Methods:We prospectively enrolled 16 consecutive adults with Fontan circulation (age 31.3 ± 8.5 years), who were in New York Heart Association Functional class II-IV. Twenty with tetralogy of Fallot (TOF), and 20 age-matched controls also underwent cardiac magnetic resonance (CMR) imaging at 3T. Myocardial T 1 mapping with a Modified Look-Locker Inversion recovery sequence was applied to liver T 1 mapping. Patients in the Fontan group underwent the right heart catheter and liver function tests, including those for fibrotic markers.Results: Liver native T 1 values in the Fontan group were significantly higher than that in TOF and controls (P < 0.001). In the Fontan group, the liver native T 1 value was significantly correlated with age, g -glutamyltransferase, model for end-stage liver disease XI score, and albumin-bilirubin score (P = 0.01, 0.01, 0.044, 0.001). However, it demonstrated no correlation with central venous pressure, pulmonary vessel resistance, or fibrotic markers. Conclusion:Liver native T 1 value derived from CMR may be a non-invasive adjunctive and/or screening marker to detect FALD.

Spectroscopy‐based multi‐parametric quantification in subjects with liver iron overload at 1.5T and 3T

“…This demonstrates that the effect of iron on R 1 water is similar at 1.5T and 3T, and R 1 water measurements are simply shifted due to the difference in the “baseline” R 1 water of liver tissue between the 2 field strengths. The observed shift in R 1 water agrees relatively well with previously reported values of R 1 in the liver at 1.5T and 3T 26,31,34,35 . R 1 water also demonstrates a weaker dependence on LIC in comparison to R 2 water and FWHM water .…”

“…Additionally, the agreement between the MR biomarkers estimated using STEAM‐MRS and the same biomarkers estimated using reference imaging methods was not evaluated in this work. However, previous studies have reported excellent agreement between MRS‐ PDFF and MRI‐ PDFF , 54‐57 and the R 1 and R 2 values reported here agree with values typically reported throughout the literature 23,26,27,31,34,35 …”

“…The observed shift in R1 water agrees relatively well with previously reported values of R1 in the liver at 1.5T and 3T. 26,31,34,35 R1 water also demonstrates a weaker dependence on LIC in comparison to R2 water and FWHM water . 4.2.2 | Relationships between field strengths When examining the relationships between estimates at 1.5T and 3T, PDFF demonstrated excellent reproducibility F I G U R E 3 Reproducibility (multi-TE vs. multi-TE-TR) STEAM-MRS Bland-Altman plots for R2 water (first column), FWHM water (second column), and PDFF (third column) at 1.5T (first row) and 3T (second row) for the retest acquisition.…”

“…However, previous studies have reported excellent agreement between MRS-PDFF and MRI-PDFF, [54][55][56][57] and the R1 and R2 values reported here agree with values typically reported throughout the literature. 23,26,27,31,34,35 (dashed curves) are displayed. Data points are color coded based on sex (blue for male and green for female).…”

Pulse Sequences and Reconstruction in Fast MR Imaging of the Liver

“…It has been reported that T 1 measurement after gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) administration could be used to evaluate hepatocyte function. 47,48 Advancements in motion monitoring and motion correction opened the door to free-breathing liver T 1 dynamic acquisition. 30,32 Liver motion was monitored by external devices or navigator pulse sequence 49 for years; however, recent advanced radial k-space acquisition methods can detect motion information from acquired k-space data itself.…”