Original ContributionQuantitative MRI of the liver: Evaluation of extracellular volume fraction and other quantitative parameters in comparison to MR elastography for the assessment of hepatopathy
Introduction
Liver cirrhosis as the irreversible end stage of chronic liver injury from various etiologies poses a worldwide significant health problem due to an increasing incidence accompanied by high morbidity and mortality [1,2]. It carries the risk of portal hypertension, carcinogenesis and liver failure, and the only curative therapeutic approach is orthotopic liver transplantation. Therefore, an early diagnosis of potentially reversible stages of diffuse liver diseases, e.g., mild or moderate fibrosis, and the ability to monitor treatment response is desirable [3]. However, the gold standard for detection and staging of liver fibrosis remains liver biopsy, suffering from sampling error and periprocedural, potentially life-threatening risks due to its invasive nature [4,5]. As the most accurate non-invasive tests to date for the evaluation of liver fibrosis, elastography techniques using ultrasound (USE) and more recently magnetic resonance (MRE) have increasingly gained attention [6]. Since these methods still have several limitations and are not widely available, there is still a need for diagnostic tools allowing for a reliable assessment of liver fibrosis. Quantitative magnetic resonance imaging (MRI) techniques, such as T1 mapping and computation of extracellular volume fraction (ECV), have shown promising results in grading fibrotic change in other body regions, such as the heart [7,8] and the kidneys [9,10]; however, due to limited data [[11], [12], [13]], the diagnostic value of ECV calculation for assessment of liver fibrosis, especially in clinical routine, still remains undefined. Thus, the purpose of this study was to evaluate the diagnostic potential of ECV for assessing the severity of liver disease and detection of cirrhosis in patients with hepatopathy in comparison to other quantitative MR measures and serological surrogate markers of liver disease.
Section snippets
Materials and methods
In this prospective study, the usefulness of different fast MRI mapping techniques and the calculated ECV for assessing the severity of liver disease was evaluated. The study was approved by the institutional review board and informed consent was obtained from all participants.
Results
A total of 109 participants (61 men) were enrolled in this study with an average age of 50.7 ± 16.1 years. In 67 patients, diagnosis was established by biopsy; in only 15 patients histology was acquired close to the MRI examination date. The main characteristics of the study population are summarized in Table 1. As T2* was invariably >10.07 ms, no one was excluded for iron overload.
Discussion
Several non-invasive tests for diagnosis and monitoring manifestations of diffuse hepatopathy have been introduced lately to avoid liver biopsy [18]. However, all of them suffer from substantial limitations preventing them from being routinely used in clinical practice. Quantitative MRI techniques, particularly the computation of hepatic ECV, have recently gained attention due to their potential to overcome some of the most common drawbacks encountered with these tests [12,19]. Therefore, the
Conclusion
This study highlights ECV provided by quantitative liver MRI as a novel and promising non-invasive tool for the assessment of liver diseases. Especially its high accuracy in detecting liver cirrhosis and the easy implementation of the required technique in clinical routine examinations renders ECV a noteworthy alternative to magnetic resonance elastography (MRE). The significance of ECV for the assessment of earlier stages of liver fibrosis, particularly in comparison to MRE, should be
References (34)
- et al.
Liver cirrhosis
Lancet
(2014) - et al.
Burden of liver disease in Europe: epidemiology and analysis of risk factors to identify prevention policies
J Hepatol
(2018) - et al.
Assessment of myocardial fibrosis with T1 mapping MRI
Clin Radiol
(2016) - et al.
Increased extracellular volume in the liver of pediatric Fontan patients
J Cardiovasc Magn Reson
(2019) - et al.
Assessing liver fibrosis in chronic hepatitis B using MR extracellular volume measurements: comparison with serum fibrosis indices
Magn Reson Imaging
(2019) - et al.
Multiparametric magnetic resonance for the non-invasive diagnosis of liver disease
J Hepatol
(2014) - et al.
MR relaxometry in chronic liver diseases: comparison of T1 mapping, T2 mapping, and diffusion-weighted imaging for assessing cirrhosis diagnosis and severity
Eur J Radiol
(2015) - et al.
Multiparametric magnetic resonance imaging predicts clinical outcomes in patients with chronic liver disease
J Hepatol
(2016) - et al.
Noninvasive hematocrit assessment for cardiovascular magnetic resonance extracellular volume quantification using a point-of-care device and synthetic derivation
J Cardiovasc Magn Reson
(2018) - et al.
Liver fibrosis staging using T1 mapping on gadoxetic acid-enhanced MRI compared with DW imaging
Clin Radiol
(2015)
Regression of liver fibrosis
Semin Liver Dis
Findings of the UK national audit evaluating image-guided or image-assisted liver biopsy. Part II. Minor and major complications and procedure-related mortality
Radiology
Liver biopsy
N Engl J Med
Liver fibrosis: review of current imaging and MRI quantification techniques
J Magn Reson Imaging
State of the art: clinical applications of cardiac T1 mapping
Radiology
New magnetic resonance imaging index for renal fibrosis assessment: a comparison between diffusion-weighted imaging and T1 mapping with histological validation
Sci Rep
T1-mapping for assessment of ischemia-induced acute kidney injury and prediction of chronic kidney disease in mice
Eur Radiol
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