Abstract
PurposeTo compare liver stiffness (LS) in patients with suspected diffuse liver disease between gradient-recalled-echo magnetic resonance elastography (GRE-MRE) and different spin-echo echo-planar imaging (SE-EPI-MRE) sequences and to investigate confounding factors including fat, iron, age, and sex. MethodLS was measured at 1.5T using GRE-MRE, SE-EPI-MRE and short-TE-SE-EPI-MRE (hiSE-EPI-MRE) sequences and compared using Bland-Altman-plots together with concordance correlation coefficients (CCC). Success gradings were evaluated considering possible confounding factors. Results305 patients (225 male, 80 females, mean age 51.12 years) were included. 109/305 showed hepatic iron overload, 183 hepatic steatosis. The mean difference (bias) in stiffness values between GRE-MRE and SE-EPI-MRE/hiSE-EPI-MRE was 0.15/0.2 kPa (LOA: −0.72,0.41 kPa/-0.94,0.55 kPa), between SE-EPI-MRE and hiSE-EPI-MRE 0.04 kPa (LOA: −0.62,0.53 kPa). The CCC for agreement between stiffness values for GRE-MRE and SE-EPI-MRE was 0.94 (0.92–0.95), 0.89 (0.86–0.91) for hiSE-EPI-MRE and GRE-MRE and 0.94 (0.92–0.95) for SE-EPI-MRE and hiSE-EPI-MRE. Using GRE-MRE, 72/305 showed unusable results whereby all these patients had high iron levels (mean R2*=209.7 1/s). For SE-EPI-MRE and hiSE-EPI-MRE only 10/305 and 8/305 were inconclusive respectively, corresponding to a significantly higher iron load (mean R2*= 549.2 1/s for SE-EPI-MRE and 570.7 1/s for hiSE-EPI-MRE). Concerning fat, age or sex no significant influence on success was observed for all sequences. ConclusionsGood agreement of LS values was observed between GRE-MRE and SE-EPI-MRE sequences. The number of successful exams, however, was considerably lower for GRE-MRE, mainly due to iron content.Study reference number: AN5093.
Highlights
Magnetic resonance elastography (MRE) is used to quantitatively evaluate liver stiffness (LS)
Compared to gradient-recalledecho magnetic resonance elastography (GRE-MRE) the median stiffness values were found to be slightly lower for SE-EPI-MRE and hiSE-EPI-MRE (p < 0.01), whereas no difference was found between SE-EPI-MRE and hiSEEPI-MRE (p > 0.5)
With GRE-MRE we found a total failure in a considerably higher number of patients (23.6%) compared with SE-EPI-MRE (3.3%) and hiSE-EPI-MRE (2.6%), whereby failure could mainly be attributed to hepatic iron overload
Summary
Magnetic resonance elastography (MRE) is used to quantitatively evaluate liver stiffness (LS). Due to its higher accuracy in the detection of hepatic fibrosis as compared to vibration-controlled transient-elastog raphy (VCTE) [1,2] it is increasingly demanded by clinicians in daily routine. Different MRE sequences including gradient-recalled echo (GRE-MRE) and spin-echo echo-planar imaging (SE-EPI-MRE) are available [3]. Based on commercial availability most published studies used GRE-MRE sequences which are robust and well verified [4]. Limitations such as serial breath-holds and the potential in fluence of steatosis or iron overload have been described [5,6].
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