Magnetic resonance elastography (MRE) in assessing hepatic fibrosis: performance in a cohort of patients with histological data

Batheja, Mashal; Vargas, Hugo E.; Silva, Annelise M.; Walker, F. Blake; Chang, Yu Hui; Petris, Giovanni De; Silva, Alvin C.

doi:10.1007/s00261-014-0321-8

Cited by 31 publications

(31 citation statements)

References 27 publications

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“…With a 3.0-T Philips system, similarly excellent repeatability has been shown by using a 2D GRE sequence, with a bias of just 0.21 kPa between repeated measures of liver stiffness acquired in the same patients on the same day (25). It is interesting that the greatest test-retest repeatability observed in our study was liver stiffness as an imaging surrogate for parenchymal fibrosis (1,3,22,23). For this diagnostic test to gain wide acceptance, reliability of results must be demonstrated.…”

Section: Overall and Subpopulation Agreementsupporting

confidence: 59%

“…M agnetic resonance (MR) elastography is a noninvasive means of assessing hepatic stiffness that has been shown to correlate well with histopathologic grading of fibrosis, potentially obviating biopsy and its attendant risks in some patients (1)(2)(3)(4)(5)(6)(7)(8)(9). Quantitative stiffness images (elastograms) of the liver can be rapidly obtained during breath-hold acquisitions and, therefore, can be readily included in conventional liver MR imaging protocols or obtained as a short dedicated GASTROINTESTINAL IMAGING: Agreement and Repeatability of MR Elastography Trout et al between repeat imaging with the same MR elastography sequence on the same imaging system.…”

Section: Implications For Patient Carementioning

confidence: 99%

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Liver Stiffness Measurements with MR Elastography: Agreement and Repeatability across Imaging Systems, Field Strengths, and Pulse Sequences

Trout¹,

Serai²,

Mahley³

et al. 2016

Radiology

113

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Purpose To prospectively assess agreement and repeatability of magnetic resonance (MR) elastography liver stiffness measurements across imager manufacturers, field strengths, and pulse sequences. Materials and Methods This prospective cross-sectional study was approved by the institutional review board; informed consent was obtained from all subjects. On the basis of an a priori power calculation, 24 volunteer adult subjects underwent MR elastography with four MR imaging systems (two vendors) and multiple pulse sequences (two-dimensional [2D] gradient-echo [GRE] imaging, 2D spin-echo [SE] echo-planar imaging, and three-dimensional [3D] SE echo-planar imaging). Each sequence was performed twice in each patient with each imaging system. Intraclass correlation coefficients (ICCs) were used to assess agreement and repeatability. P < .05 was considered indicative of a statistically significant difference. Results Pairwise ICCs were 0.67-0.82 and 0.62-0.83 for agreement between pulse sequences across manufacturers (n = 4) and field strengths (n = 5), respectively. ICCs were 0.45-0.90 for pairwise agreement between sequences while fixing manufacturer and field strength (n = 8). Test-retest repeatability across the various manufacturer, field strength, and pulse sequence combinations (n = 10) was excellent (ICCs, 0.77-0.94). The overall ICC for all manufacturer, field strength, and sequence combinations (n = 10) was 0.68 (95% confidence interval [CI]: 0.55, 0.82). ICC according to field strength was 0.78 (95% CI: 0.67, 0.88) at 1.5 T (n = 5) and 0.64 (95% CI: 0.49, 0.78) at 3.0 T (n = 5). ICCs according to vendor were 0.83 (95% CI: 0.73, 0.91) (n = 4) and 0.65 (95% CI: 0.51, 0.79) (n = 6). Average patient level variance was 0.042 kPa, with a coefficient of variation of 10.7%. Conclusion MR elastography is a reliable method for assessing liver stiffness, with small amounts of variability between imager manufacturers, field strengths, and pulse sequences. RSNA, 2016.

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Section: Overall and Subpopulation Agreementsupporting

confidence: 59%

Section: Implications For Patient Carementioning

confidence: 99%

Liver Stiffness Measurements with MR Elastography: Agreement and Repeatability across Imaging Systems, Field Strengths, and Pulse Sequences

Trout¹,

Serai²,

Mahley³

et al. 2016

Radiology

113

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“…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.…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

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

Kim

Yoon

et al. 2019

Magnetic Resonance Imaging

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Background Magnetic resonance elastography (MRE) using a gradient‐recalled echo (GRE) or a recently available spin‐echo echo‐planar imaging (SE‐EPI) sequence is a promising noninvasive method for measuring liver stiffness. However, it sometimes fails to measure stiffness values, thereby resulting in technical failures. Purpose To assess and compare technical failures of MRE for measuring liver stiffness between GRE and SE‐EPI sequences. Study Type Systematic review and meta‐analysis. Population Eight studies with both GRE and SE‐EPI, 22 studies with only GRE, one study with only SE‐EPI. Field Strength/Sequence Either 1.5 or 3T MRE using GRE and/or SE‐EPI. Assessment Through an Ovid‐MEDLINE and EMBASE database search, original articles investigating the proportion of MRE technical failures in the measurement of liver stiffness published up until October 2018 were screened and selected. Statistical Analysis The pooled proportions of technical failures under GRE and SE‐EPI were calculated using random‐effects meta‐analysis of single proportions and inverse variance for calculating weights. Subgroup analyses were performed to explore the covariates affecting heterogeneity. Head‐to‐head comparisons of technical failure between the sequences were conducted with eight MRE studies using both GRE and SE‐EPI. Results The pooled proportion of technical failure under GRE MRE was 5.8% (95% confidence interval [CI], 4.6–7.4%), and a subgroup analysis showed higher technical failure rates at 3T than at 1.5T. The pooled proportion of technical failure under SE‐EPI MRE was 2.0% (95% CI, 1.3–3.4%), without significant differences (P = 0.38–0.89) being observed in the subgroup analyses. In the eight studies comparing the two sequences, failure was more frequently observed with GRE than with SE‐EPI (9.4% vs. 1.9%; P < 0.01). Data Conclusion MRE conducted with SE‐EPI sequences showed a lower technical failure rate than GRE sequences. With GRE sequences, a magnetic field of 3T was associated with higher technical failure rates than was 1.5T. Level of Evidence: 1 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2020;51:1086–1102.

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“…Biopsies were taken 1.62 ± 1.75 years (mean ± sd ) before blood was sampled for analyses. Participants were then stratified into the following two groups: severe fibrosis (scores 3 or 4 points, i.e., F3/F4, n = 9) and nonsevere or no fibrosis (scores 0, 1, or 2 points, i.e., F0–F2, n = 17) …”

Section: Methodsmentioning

confidence: 99%

Leukocyte extracellular vesicle concentration is inversely associated with liver fibrosis severity in NAFLD

Welsh

Scorletti

Clough

et al. 2018

Journal of Leukocyte Biology

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The enhanced liver fibrosis (LFS) score and the nonalcoholic fatty liver disease (NAFLD) fibrosis score (NFS) are algorithmic-derived scores for diagnosing severe (F3/F4) liver fibrosis. In a pilot, substudy of the Wessex Evaluation of fatty Liver and Cardiovascular markers in NAFLD with OMacor thErapy (WELCOME) trial, we tested whether measurements of plasma platelet-, endothelial-, and leukocyte-derived extracellular vesicles (EVs) counts are (a) associated with, and predict, F3/F4 fibrosis and (b) able to improve risk prediction of F3/F4 fibrosis in NAFLD, building upon LFS or NFS algorithms. Twenty-six individuals with NAFLD had liver fibrosis severity determined by Kleiner scoring after liver biopsy. Plasma samples stained with CD41a, CD42b, CD31, CD105, CD14, CD16, and CD284 antibodies were analyzed using flow cytometry to measure platelet-, endothelial-, and leukocyte-derived EVs counts. The independence of associations between EVs and F3/F4 fibrosis were tested using logistic regression. Receiver operator characteristic (ROC) curves were used to evaluate F3/F4 fibrosis prediction models. LFS was more strongly associated with F3/F4 fibrosis than NFS (χ2= 15.403, P < 0.0001, and χ2= 6.300, P = 0.012, respectively). The association between LFS and F3/F4 fibrosis was further improved by addition of CD14 EVs (χ2=20.847,P = 0.016 vs. χ2=12.803,P = 0.015, respectively) or CD16 EVs (χ2=22.205,P = 0.009 vs. χ2=17.559,P = 0.001, respectively), and the area under the ROC for LFS (AUC = 0.915, se = 0.055, P = 0.001) was increased by the addition of CD14 or CD16 EVs (AUC = 0.948, se = 0.042, and P < 0.001 and AUC = 0.967, se = 0.055, P < 0.001, respectively) as predictor variables. In this small preliminary study, CD14 and CD16 EV counts show potential to predict liver fibrosis severity with either marker improving the ability of the LFS to identify F3/F4 fibrosis in this small preliminary cohort study.

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Magnetic resonance elastography (MRE) in assessing hepatic fibrosis: performance in a cohort of patients with histological data

Abstract: Our analysis supports previous findings that MRE is a non-invasive and effective method for detection and assessment of liver fibrosis, particularly for discrimination between F0-2 stages and F3-4 stages. MRE may represent a valuable tool to finely discern hepatic fibrosis non-invasively.

Cited by 31 publications

References 27 publications

Liver Stiffness Measurements with MR Elastography: Agreement and Repeatability across Imaging Systems, Field Strengths, and Pulse Sequences

Liver Stiffness Measurements with MR Elastography: Agreement and Repeatability across Imaging Systems, Field Strengths, and Pulse Sequences

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

Leukocyte extracellular vesicle concentration is inversely associated with liver fibrosis severity in NAFLD

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