Technical Failure of MR Elastography Examinations of the Liver: Experience from a Large Single-Center Study

Abstract

Purpose To assess the determinants of technical failure of magnetic resonance (MR) elastography of the liver in a large single-center study. Materials and Methods This retrospective study was approved by the institutional review board. Seven hundred eighty-one MR elastography examinations performed in 691 consecutive patients (mean age, 58 years; male patients, 434 [62.8%]) in a single center between June 2013 and August 2014 were retrospectively evaluated. MR elastography was performed at 3.0 T (n = 443) or 1.5 T (n = 338) by using a gradient-recalled-echo pulse sequence. MR elastography and anatomic image analysis were performed by two observers. Additional observers measured liver T2* and fat fraction. Technical failure was defined as no pixel value with a confidence index higher than 95% and/or no apparent shear waves imaged. Logistic regression analysis was performed to assess potential predictive factors of technical failure of MR elastography. Results The technical failure rate of MR elastography at 1.5 T was 3.5% (12 of 338), while it was higher, 15.3% (68 of 443), at 3.0 T. On the basis of univariate analysis, body mass index, liver iron deposition, massive ascites, use of 3.0 T, presence of cirrhosis, and alcoholic liver disease were all significantly associated with failure of MR elastography (P < .004); but on the basis of multivariable analysis, only body mass index, liver iron deposition, massive ascites, and use of 3.0 T were significantly associated with failure of MR elastography (P < .004). Conclusion The technical failure rate of MR elastography with a gradient-recalled-echo pulse sequence was low at 1.5 T but substantially higher at 3.0 T. Massive ascites, iron deposition, and high body mass index were additional independent factors associated with failure of MR elastography of the liver with a two-dimensional gradient-recalled-echo pulse sequence. RSNA, 2017.

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

“…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. As a result, we conducted the systematic review and meta‐analyses on 29 studies using GRE sequences and nine studies using SE‐EPI sequences, and compared differences in technical failure rates between the two sequence types using data from eight studies …”

“…The demographic characteristics of the included studies are shown in Table . In brief, subjects were enrolled prospectively in 16 studies and retrospectively in 15 studies , , , , , , , . The mean patient ages in 14 studies , , , , , , , , ranged from 25 to 60.5 years, but we could not analyze patient age in the other studies, because they did not report demographic information on all subjects, but reported only those with successful examinations.…”

“…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.…”

Evaluation of hepatic fibrosis: a review from the society of abdominal radiology disease focus panel

“…Most studies have indicated that steatosis does not have significant effect on MR elastography assessed liver stiffness [97,98,106], although obesity can play a small role in MR elastography failure [107]. Liver stiffness may be elevated in the absence of significant fibrosis in patients with acute alcohol intoxication, acute hepatitis, acute flares of chronic hepatitis, biliary obstruction, chronic inflammation, and passive congestion due to cardiac failure or other cardiac conditions.…”

“…The current clinical MR elastography sequence (2D GRE) may fail in patients with moderate to severe hepatic iron deposition [102], contributing to a failure rate in one meta-analysis of 4.3% [93]. Another recent study showed the technical failure rate of MR elastography at 1.5 T was 3.5%, with independent risk factors associated with failure of MR elastography including massive ascites, iron deposition, and high body mass index [107]. This limitation from iron deposition is secondary to the low parenchymal signal, however the shear waves still traverse through the liver but are not visualized and do not have enough signal intensity for post processing by the inversion algorithm.…”