T1 mapping, T2 mapping and MR elastography of the liver for detection and staging of liver fibrosis

Hoffman, David H.; Ayoola, Abimbola; Nickel, Dominik; Han, Fei; Chandarana, Hersh; Shanbhogue, Krishna

doi:10.1007/s00261-019-02382-9

Cited by 71 publications

(96 citation statements)

References 35 publications

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“…Like ECV, T1 mapping seems to be more liver specific than laboratory markers as changes in hepatic T1 are measured directly in the liver parenchyma. In contrast to a previous study [21], which also showed positive correlation between MRE-based liver stiffness and hepatic T1 mapping (r = 0.49), our correlation was stronger (r = 0.69), likely because of the heterogeneous group of patients in the previous study with liver disease of different etiologies (including hepatitis B and C, non-alcoholic fatty liver disease, AIH, primary sclerosing cholangitis, and primary biliary cholangitis). In contrast to previous data [21], we did not find significant correlation between T2 relaxation times and MREbased liver stiffness in patients with AIH.…”

Section: Discussioncontrasting

confidence: 99%

“…Moreover, recently published studies have already shown positive correlations between hepatic T1, T2, and ECV with liver fibrosis in both animal and human models [15,[18][19][20]36]. There are also studies showing positive correlations between T1, T2 mapping parameters and MRE with liver fibrosis, however, without focusing on AIH patients [21,37]. One of the most studied tools for non-invasive assessment of liver fibrosis in patients with AIH is liver stiffness measurement derived by TE (FibroScan) [38,39].…”

Section: Discussionmentioning

confidence: 99%

“…Prolonged T2 relaxation times in regions of fibrosis are potentially attributable to the coexistent inflammation and high water content of the advanced fibrosis. There have been several studies showing correlations between hepatic T1, T2, and ECV with liver fibrosis in both animal and human models [15][16][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

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Non-invasive assessment of liver fibrosis in autoimmune hepatitis: Diagnostic value of liver magnetic resonance parametric mapping including extracellular volume fraction

et al. 2020

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Purpose Autoimmune hepatitis (AIH) is an immune-mediated chronic liver disease that leads to severe fibrosis and cirrhosis. The aim of this study was to determine the diagnostic value of T1 and T2 mapping as well as extracellular volume fraction (ECV) for non-invasive assessment of liver fibrosis in AIH patients. Methods In this prospective study, 27 patients (age range: 19–77 years) with AIH underwent liver MRI. T1 and T2 relaxation times as well as ECV were quantified by mapping techniques. The presence of significant fibrosis (≥ F2) was defined as magnetic resonance elastography (MRE)-based liver stiffness ≥ 3.66 kPa. MRE was used as reference standard, against which the diagnostic performance of MRI-derived mapping parameters was tested. Diagnostic performance was compared by utilizing receiver-operating characteristic (ROC) analysis. Results MRE-based liver stiffness correlated with both, hepatic native T1 (r = 0.69; P < 0.001) as well as ECV (r = 0.80; P < 0.001). For the assessment of significant fibrosis, ECV yielded a sensitivity of 85.7% (95% confidence interval (CI): 60.1–96.0%) and a specificity of 84.6% (CI 60.1–96.0%); hepatic native T1 yielded a sensitivity of 85.7% (CI 60.1–96.0%); and a specificity of 76.9% (CI 49.7–91.8%). Diagnostic performance of hepatic ECV (area under the curve (AUC): 0.885), native hepatic T1 (AUC: 0.846) for assessment of significant fibrosis was similar compared to clinical fibrosis scores (APRI (AUC: 0.852), FIB-4 (AUC: 0.758), and AAR (0.654) (P > 0.05 for each comparison)). Conclusion Quantitative mapping parameters such as T1 and ECV can identify significant fibrosis in AIH patients. Future studies are needed to explore the value of parametric mapping for the evaluation of different disease stages.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Non-invasive assessment of liver fibrosis in autoimmune hepatitis: Diagnostic value of liver magnetic resonance parametric mapping including extracellular volume fraction

et al. 2020

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“…Liver fibrosis also leads to an increased accumulation of extracellular MRI contrast agents in the extracellular space, which can be measured via ECV assessment. Histopathological studies show correlations between hepatic T1, T2, and ECV with liver fibrosis, as well as hepatic ECV and portal pressure in both animal and human models [8,13,14,[21][22][23]. There are also studies mentioning positive correlations between mapping parameters and magnetic resonance elastography (MRE) [22,24,25].…”

Section: Discussionmentioning

confidence: 98%

Magnetic resonance parametric mapping of the spleen for non-invasive assessment of portal hypertension

et al. 2020

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Objectives In patients with advanced liver disease, portal hypertension is an important risk factor, leading to complications such as esophageal variceal bleeding, ascites, and hepatic encephalopathy. This study aimed to determine the diagnostic value of T1 and T2 mapping and extracellular volume fraction (ECV) for the non-invasive assessment of portal hypertension. Methods In this prospective study, 50 participants (33 patients with indication for trans-jugular intrahepatic portosystemic shunt (TIPS) and 17 healthy volunteers) underwent MRI. The derivation and validation cohorts included 40 and 10 participants, respectively. T1 and T2 relaxation times and ECV of the liver and the spleen were assessed using quantitative mapping techniques. Direct hepatic venous pressure gradient (HVPG) and portal pressure measurements were performed during TIPS procedure. ROC analysis was performed to compare diagnostic performance. Results Splenic ECV correlated with portal pressure (r = 0.72; p < 0.001) and direct HVPG (r = 0.50; p = 0.003). No significant correlations were found between native splenic T1 and T2 relaxation times with portal pressure measurements (p > 0.05, respectively). In the derivation cohort, splenic ECV revealed a perfect diagnostic performance with an AUC of 1.000 for the identification of clinically significant portal hypertension (direct HVPG ≥ 10 mmHg) and outperformed other parameters: hepatic T2 (AUC, 0.731), splenic T2 (AUC, 0.736), and splenic native T1 (AUC, 0.806) (p < 0.05, respectively). The diagnostic performance of mapping parameters was comparable in the validation cohort. Conclusion Splenic ECV was associated with portal pressure measurements in patients with advanced liver disease. Future studies should explore the diagnostic value of parametric mapping accross a broader range of pressure values. Key Points • Non-invasive assessment and monitoring of portal hypertension is an area of unmet interest. • Splenic extracellular volume fraction is strongly associated with portal pressure in patients with end-stage liver disease. • Quantitative splenic and hepatic MRI-derived parameters have a potential to become a new non-invasive diagnostic parameter to assess and monitor portal pressure.

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“…Other groups have found that the hepatobiliary phase (HBP) T1 relaxation time significantly correlated with the fibrosis stage and necroinflammatory activity grade. However, although the HBP T1 relaxation time had a high diagnostic accuracy for stage 3 fibrosis (AUROC of 0.82), its diagnostic accuracy for grade 3 necroinflammatory activity was relatively low (AUROC of 0.68) [56,57]. The authors found that HBP T1 relaxation times were better at differentiating stage 2 from stage 3 fibrosis than at distinguishing grade 2 from grade 3 necroinflammatory activity (Fig.…”

Section: Liver Fibrosismentioning

confidence: 99%

Quantification of liver function using gadoxetic acid-enhanced MRI

et al. 2020

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The introduction of hepatobiliary contrast agents, most notably gadoxetic acid (GA), has expanded the role of MRI, allowing not only a morphologic but also a functional evaluation of the hepatobiliary system. The mechanism of uptake and excretion of gadoxetic acid via transporters, such as organic anion transporting polypeptides (OATP1,3), multidrug resistance-associated protein 2 (MRP2) and MRP3, has been elucidated in the literature. Furthermore, GA uptake can be estimated on either static images or on dynamic imaging, for example, the hepatic extraction fraction (HEF) and liver perfusion. GA-enhanced MRI has achieved an important role in evaluating morphology and function in chronic liver diseases (CLD), allowing to distinguish between the two subgroups of nonalcoholic fatty liver diseases (NAFLD), simple steatosis and nonalcoholic steatohepatitis (NASH), and help to stage fibrosis and cirrhosis, predict liver transplant graft survival, and preoperatively evaluate the risk of liver failure if major resection is planned. Finally, because of its noninvasive nature, GA-enhanced MRI can be used for long-term follow-up and post-treatment monitoring. This review article aims to describe the current role of GA-enhanced MRI in quantifying liver function in a variety of hepatobiliary disorders.

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T1 mapping, T2 mapping and MR elastography of the liver for detection and staging of liver fibrosis

Cited by 71 publications

References 35 publications

Non-invasive assessment of liver fibrosis in autoimmune hepatitis: Diagnostic value of liver magnetic resonance parametric mapping including extracellular volume fraction

Non-invasive assessment of liver fibrosis in autoimmune hepatitis: Diagnostic value of liver magnetic resonance parametric mapping including extracellular volume fraction

Magnetic resonance parametric mapping of the spleen for non-invasive assessment of portal hypertension

Quantification of liver function using gadoxetic acid-enhanced MRI

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