Liver T2 Research Articles

Pulmonary function in patients with transfusion-dependent thalassemia and its associations with iron overload

In patients with transfusion-dependent thalassemia (TDT), pulmonary function impairment has been reported but data are conflicting. Moreover, it remains unclear whether pulmonary dysfunction is associated with iron overload. This study aimed to evaluate the pulmonary function in patients with TDT and to investigate the associations between pulmonary dysfunction and iron overload. It was a retrospective observational study. 101 patients with TDT were recruited for lung function tests. The most recent ferritin levels (pmol/L) and the magnetic resonance imaging (MRI) measurements of the myocardial and liver iron status, as measured by heart and liver T2* relaxation time (millisecond, ms) respectively, were retrieved from the computerized medical records. Only data within 12 months from the lung function measurement were included in the analysis. The serum ferritin, and the cardiac and liver T2* relaxation time were the surrogate indexes of body iron content. The threshold of abnormality in lung function was defined as under 80% of the predicted value. 101 subjects were recruited with a mean age of 25.1 years (standard deviation (SD) 7.9 years). Thirty-eight (38%) and five (5%) demonstrated restrictive and obstructive lung function deficits, respectively. A weak correlation of FVC %Predicted and TLC %Predicted with MRI myocardial T2* relaxation time (rho = 0.32, p = 0.03 and rho = 0.33, p = 0.03 respectively) was observed. By logistic regression, MRI cardiac T2* relaxation time was negatively associated with restrictive lung function deficit (B − 0.06; SE 0.03; Odds ratio 0.94; 95% confidence interval (CI) 0.89–0.99; p = 0.023) after adjusting for age, sex and body mass index. Restrictive pulmonary function deficit was commonly observed in patients with TDT, and the severity potentially correlates with myocardial iron content. Monitoring of lung function in this group of patients, particularly for those with iron overload, is important.

Effect of standard phlebotomy on myocardial and hepatic iron levels in newly diagnosed cardiac asymptomatic hereditary hemochromatosis subjects with C282Y homozygosity.

Effect of standard phlebotomy on myocardial and hepatic iron levels in newly diagnosed cardiac asymptomatic hereditary hemochromatosis subjects with C282Y homozygosity.

Serum Ferritin Levels and Other Associated Parameters with Diabetes Mellitus in Adult Patients Suffering from Beta Thalassemia Major.

Although beta thalassemia major (BTM) patients are properly treated with blood transfusions in accompany with iron chelation therapy, they suffer from complications, such as diabetes mellitus (DM). The purpose was to detect the critical serum ferritin level and other parameters correlated with DM among adult BTM patients. Also, it was to study whether each of these parameters is associated with a certain period of age. This study included 200 adult BTM patients. A cross-sectional study was carried out. Patients clinical and laboratory variables, such as ferritin levels, and fasting blood glucose (FBS) were extracted from medical records at Zagazig University Hospital, Egypt. Liver and cardiac iron contents were assessed using MRI T2* methods. Statistical analysis was performed using IBM SPSS V26.0 software package. The overall frequency of DM over the total sample equals 6.5%. There were no impaired fasting glucose (IFG) in the medical records. Statistical significance between serum ferritin and DM was (P = 0.014). The serum ferritin 2500 ng/mL with age group (27-<32) years-old were risk factors. The distributions of DM according to BMI were (3.5%) of class overweight. Significant association between DM and BMI was (r = 0.357, P < 0.001). Liver MRI T2* has significant correlation with serum ferritin, but cardiac MRI T2* was poorly correlated. Association between liver and cardiac MRI T2* was not found. Age group (27-<32) years-old and ferritin >2500 ng/mL should be properly treated immediately. The serum ferritin and BMI of class "overweight" were risk factors for DM. Factors such as diet should be followed. Serum ferritin can be used for estimating liver iron content for economic factors. But cardiac MRI T2* must be performed for evaluating cardiac iron accurately.

Free-breathing simultaneous water-fat separation and T1 mapping of the whole liver (SWALI) with isotropic resolution using 3D golden-angle radial trajectory.

Conventional liver T1 mapping techniques are typically performed under breath-holding conditions; they have limited slice coverage and often rely on multiple acquisitions. Furthermore, liver fat affects the accuracy of T1 quantification. Therefore, we aim to propose a free-breathing technique for simultaneous water-fat separation and T1 mapping of the whole liver (SWALI) in a single scan. The proposed SWALI sequence included an inversion recovery (IR) preparation pulse followed by a series of multiecho three-dimensional (3D) golden-angle radial acquisitions. For each echo time (TE), a series of images containing a mix of water and fat were reconstructed using a sliding window method. For each inversion time (TI), water and fat were separated, and then water and fat T1 estimation was conducted. The fat fraction (FF) was calculated based on the last TI image. The FF and water T1 quantification accuracy were compared with the gold standard sequences in the phantom. The in vivo feasibility was tested in 9 healthy volunteers, 2 patients with fatty liver, and 3 patients with hepatocellular carcinoma (HCC). The reproducibility was evaluated in the patients with fatty liver and in the healthy volunteers. The mean FF and the mean water T1 values obtained by the SWALI sequence showed good agreements with chemical shift-encoded magnetic resonance imaging (CSE-MRI; r=0.998; P<0.001) and fat-suppressed (FS) IR-spin echo (SE; r=0.997; P<0.001) in the phantom. For the patients with fatty liver and the healthy volunteers, the SWALI sequence showed no significant difference with CSE-MRI in FF quantification (P=0.53). In T1 quantification, comparable T1 values were obtained with the SWALI sequence and modified Look-Locker inversion recovery (MOLLI; P=0.10) in healthy volunteers, while the water T1 estimated by the SWALI sequence was significantly lower than the water-fat compound T1 estimated by MOLLI (P<0.001) in patients with fatty liver. In the reproducibility study, the intraclass correlation coefficients (ICCs) for the estimated FF and water T1 were 0.997 and 0.943, respectively. Water T1 of the patients with HCC calculated using the SWALI sequence showed a significant reduction after the contrast administration (P<0.001). Free-breathing water-fat separation and T1 mapping of the whole liver with 2.5 mm isotropic spatial resolution were achieved simultaneously using the SWALI sequence in a 5-min scan.

Can biomarkers predict myocardial iron overload in children with thalassemia major?

Beta-thalassemia major requires regular blood transfusions throughout life, which in turn leads to iron accumulation in the body. While cardiac T2* MRI is the gold standard in determining cardiac iron accumulation, it is not always feasible, which has led to the search for new biomarkers. Herein, the value of growth differentiation factor-15, galectin-3, and N-terminal pro-B-type natriuretic peptide in predicting cardiac iron accumulation is investigated in asymptomatic children with beta-thalassemia major. Forty-one patients aged 11-21 years and 41 age-, gender-, body mass index-matched healthy controls were included. Serum growth differentiation factor-15, galectin-3, and N-terminal pro-B-type natriuretic peptide levels were compared between the patients and controls. Additionally, the relations of these biomarkers with cardiac and liver T2 * MRI were investigated in the patients. In the patients, growth differentiation factor-15, galectin-3, and N-terminal pro-B-type natriuretic peptide levels were higher than healthy controls (p < 0.001, p = 0.025, p < 0.001, respectively). There were no significant correlations of growth differentiation factor-15 and N-terminal pro-B-type natriuretic peptide levels with both cardiac and liver T2 * MRI measurements. While there was no significant correlation of serum galectin-3 with cardiac T2 * MRI measurements, a negative correlation was found with liver T2 * MRI measurements (p = 0.040, rho = -0.325). All three biomarkers investigated in this study failed to predict myocardial iron accumulation in asymptomatic children with beta-thalassemia major. However, a weak relation between serum galectin-3 level and hepatic iron accumulation was demonstrated.

Water-Fat Separated T1 Mapping in the Liver and Correlation to Hepatic Fat Fraction.

(1) Background: T1 mapping in magnetic resonance imaging (MRI) of the liver has been proposed to estimate liver function or to detect the stage of liver disease, among others. Thus far, the impact of intrahepatic fat on T1 quantification has only been sparsely discussed. Therefore, the aim of this study was to evaluate the potential of water-fat separated T1 mapping of the liver. (2) Methods: A total of 386 patients underwent MRI of the liver at 3 T. In addition to routine imaging techniques, a 3D variable flip angle (VFA) gradient echo technique combined with a two-point Dixon method was acquired to calculate T1 maps from an in-phase (T1_in) and water-only (T1_W) signal. The results were correlated with proton density fat fraction using multi-echo 3D gradient echo imaging (PDFF) and multi-echo single voxel spectroscopy (PDFF_MRS). Using T1_in and T1_W, a novel parameter FF_T1 was defined and compared with PDFF and PDFF_MRS. Furthermore, the value of retrospectively calculated T1_W (T1_W_calc) based on T1_in and PDFF was assessed. Wilcoxon test, Pearson correlation coefficient and Bland-Altman analysis were applied as statistical tools. (3) Results: T1_in was significantly shorter than T1_W and the difference of both T1 values was correlated with PDFF (R = 0.890). FF_T1 was significantly correlated with PDFF (R = 0.930) and PDFF_MRS (R = 0.922) and yielded only minor bias compared to both established PDFF methods (0.78 and 0.21). T1_W and T1_W_calc were also significantly correlated (R = 0.986). (4) Conclusion: T1_W acquired with a water-fat separated VFA technique allows to minimize the influence of fat on liver T1. Alternatively, T1_W can be estimated retrospectively from T1_in and PDFF, if a Dixon technique is not available for T1 mapping.

Imaging Non-alcoholic Fatty Liver Disease Model Using H-1 and F-19 MRI.

We explore the use of intravenously delivered perfluorocarbon (PFC) nanoemulsion and 19F MRI for detecting inflammation in a mouse model of non-alcoholic fatty liver disease (NAFLD). Correlative studies of 1H-based liver proton density fat fraction (PDFF) and T1 measurements and histology are also evaluated. C57BL/6 mice were fed standard or high-fat diet (HFD) for 6weeks to induce NAFLD. 1H MRI measurements of PDFF and T1 relaxation time were performed at baseline to assess NAFLD onset prior to administration of a PFC nanoemulsion to enable 19F MRI of liver PFC uptake. 1H and 19F MRI biomarkers were acquired at 2, 21, and 42days post-PFC to assess changes. Histopathology of liver tissue was performed at experimental endpoint. Significant increases in liver volume, PDFF, and total PFC uptake were noted in HFD mice compared to Std diet mice. Liver fluorine density and T1 relaxation time were significantly reduced in HFD mice. We demonstrated longitudinal quantification of multiple MRI biomarkers of disease in NAFLD mice. The changes in liver PFC uptake in HFD mice were compared with healthy mice that suggests that 19F MRI may be a viable biomarker of liver pathology.

Liver T1 Relaxation Quantification Using a 3-Dimensional Interleaved Look-Locker Acquisition With T2 Preparation Pulse Sequence (3D-QALAS): Comparison With Conventional 2-Dimensional MOLLI.

Changes in liver magnetic resonance imaging T1 relaxation times are associated with histologic inflammation and fibrosis. To compare liver T1 measurements obtained using a novel single-breath-hold 3-dimensional (3D) whole-liver T1 estimation method (3D-QALAS) to standard-of-care 2-dimensional (2D) modified Look-Locker (2D-MOLLI) measurements. With institutional review board approval, research magnetic resonance imaging examinations were performed in 19 participants at 1.5 T. T1 relaxometry of the liver was performed using a novel 3D whole-liver T1 estimation method (3D-QALAS) as well as a 2D modified Look-Locker (2D-MOLLI) method. The 3D method covered the entire liver in a single breath hold, whereas 2D imaging was performed at 4 anatomic levels in 4 consecutive breath holds. T1 measurements from parametric maps were obtained by a single operator, and region-of-interest area-weighted mean T1 values were calculated. Pearson correlation ( r ) was used to assess correlation between T1 estimation methods, and the paired t test and Bland-Altman analysis were used to compare agreement in T1 measurements. In 18 participants (1 participant was excluded from analysis because of respiratory motion artifacts on 3D-QALAS images), 2D-MOLLI and 3D-QALAS mean T1 measurements were strongly correlated ( r = 0.95, [95% CI: 0.87-0.98]; P < 0.0001). 2D-MOLLI T1 values were significantly longer than 3D-QALAS values (647.2 ± 87.3 milliseconds vs. 554.7 ± 75.8 milliseconds; P < 0.0001) with mean bias = 92.5 milliseconds (95% limits of agreement, 36.8, 148.2 milliseconds). Whole-liver T1 measurements obtained using a novel single-breath-hold 3D T1 estimation method correlate with a standard-of-care multiple consecutive-breath-hold 2D single-slice method but demonstrate systematic bias that should be considered or corrected when used in a clinical or research setting.

T1 mapping of the myocardium and liver in the single ventricle population.

Fontan associated liver disease (FALD) is an increasingly recognized complication of the single ventricle circulation characterized by hepatic venous congestion leading to hepatic fibrosis. Within the Fontan myocardium, fibrotic myocardial remodeling may occur and lead to ventricular dysfunction. Magnetic resonance imaging (MRI) T1 mapping can characterize both myocardial and liver properties. The aim of this study was to compare myocardial and liver T1 between single ventricle patients with and without a Fontan and biventricular controls. A retrospective study of 3 groups of patients: 16 single ventricle patients before Fontan (SVpre 2 newborns, 9 pre-Glenn, 5 pre-Fontan, 31% single right ventricle [SRV]), 16 Fontans (56% SRV) and 10 repaired d-transposition of the great arteries (TGA). Native modified Look-Locker inversion T1 times were measured in the myocardium and liver. Cardiac MRI parameters, myocardial and liver T1 values were compared in the three groups. Correlations were assessed between liver T1 and cardiac parameters. Myocardial T1 was higher in SVpre (1,056 ± 48ms) and Fontans (1,047 ± 41ms) compared to TGA (1,012 ± 48ms, P < 0.05). Increased liver T1 was found in both SVpre (683 ± 82ms) and Fontan (727 ± 49ms) patients compared to TGA patients (587 ± 58ms, P < 0.001). There was no difference between single left ventricle (SLV) versus SRV myocardial or liver T1. Liver T1 showed moderate correlations with myocardial T1 (r = 0.48, confidence interval [CI] 0.26-0.72) and ejection fraction (r = -0.36, CI -0.66-0.95) but not with other volumetric parameters. Increased liver T1 at both pre- and post-Fontan stages suggests there are intrinsic liver abnormalities early in the course of single ventricle palliation. Increased myocardial T1 and its relationship to liver T1 suggest a combination of edema from passive venous congestion and/or myocardial fibrosis occurring in this population. Liver T1 may provide an earlier marker of liver disease warranting further study.

Quantitative evaluation of functional liver reserve using the liver-to-spleen ΔR1 ratio based on gadoxetic acid-enhanced MRI: corrected for the effect of gadoxetic acid dose.

The liver T1 reduction rate can be used to assess liver function. However, higher doses of gadoxetic acid may shorten the liver T1 value in the hepatobiliary phase and increase the T1 reduction rate in patients with severe liver dysfunction, potentially overestimating liver function. To verify the relationship between the gadoxetic acid dose and the liver T1 reduction rate and ΔR1 of the liver and spleen, and to clarify whether the ΔR1 of hepatocytes, corrected for the effect of gadoxetic acid dose, could be used as an index of functional liver reserve. We enrolled 13 patients with normal liver function (NLF); and 18, 8, and 3 patients with Child-Pugh classes A (CPA), B (CPB), and C (CPC) who underwent gadoxetic acid-enhanced magnetic resonance imaging. Phase-sensitive inversion recovery sequence was performed before and at 15 min after injection and T1 maps were calculated. Liver and spleen ΔR1, liver T1 reduction rate, and the liver-to-spleen ΔR1 ratio were calculated. Only the liver-to-spleen ΔR1 ratio showed no correlation with gadoxetic acid dose in any group. The T1 reduction rate was not significantly different between the CPA and CPB + CPC groups. The liver-to-spleen ΔR1 ratio significantly differed between all groups. The liver and spleen ΔR1 was dependent on the dose of gadoxetic acid in severe liver dysfunction. The liver-to-spleen ΔR1 ratio improves the delineation of the CPA and CPB + CPC groups.

Abstract 12257: Prognostic Value of Liver T1 Mapping and Extracellular Volume in Dilated Cardiomyopathy

Introduction: Cardiac dysfunction closely correlates with liver congestion and effect on liver relaxation time. Liver relaxometry could provide potential prognostic improvement for dilated cardiomyopathy (DCM) patients. Hypothesis: Liver relaxometry might have prognostic significance for DCM patients. Methods: We prospectively enrolled 433 patients diagnosed with DCM. Cardiac and hepatic T1, T2, and extracellular volume (ECV) were measured on the mid-ventricular mappings. The primary endpoint was defined as heart failure death, sudden cardiac death, and heart transplantation. Results: DCM patients who reached primary endpoint showed significantly increased liver native T1 (770.5±103.2ms versus 813.8±137.0ms, p=0.014) and ECV values (30.9±6.8% versus 34.3±10.7%, p=0.009) and decreased liver T2 value (35.8±5.5 versus 34.1±6.2ms, p=0.038). Right ventricular ejection fraction correlated moderately but significantly with liver native T1 (r =-0.293) and ECV (r=-0.245) (both p&lt;0.001). During the follow-up period (median duration 3.9 years) 97 patients reached the primary endpoint. In the Kaplan-Meier survival analysis, DCM patients with elevated liver native T1 or ECV had higher risk of reaching the primary endpoint (cutoff value: 854.9ms, p=0.001 and cutoff value: 34.5%, p&lt;0.001, respectively). Cox analysis indicated that liver ECV was an independent prognostic factor (hazard ratio:1.042, p&lt;0.001) and showed incremental prognostic value to age, sex, NYHA class III-IV, and LVEF. Conclusions: Liver native T1 and ECV correlates with cardiac magnetic resonance parameters. Furthermore, Liver ECV provides incremental prognostic value in DCM patients.

Comparative Study on the Measurement of Liver LICdw between Ferriscan and T2* Based LICdw Obtained by Different Software's.

To explore the relationship between the liver iron concentration (LICF) from FerriScan and T2* based LIC obtained by Circle Cardiovascular Imaging CVI42 (CVI42), CMRtools/Thalassemia Tools (CMRtools), and Excel spreadsheet (Excel). Liver T2* values in 78 thalassemia patients were measured using CVI42, CMRtools, and Excel. Then the Garbowski formula was used to obtain LIC from T2*. Finally, the relationship of the LIC measured by the above three software and the LICF were compared. There was no statistical difference between the T2* values measured by CVI42, CMRtools, and Excel (P>0.05), but there was a high degree of consistency between them (P<0.001), and there was a high linear positive correlation between them (P<0.001). There was no statistical difference between the LIC clinical grading results of CVI42, CMRtools, and Excel and LICF grading results (P>0.05), and they were highly consistent (P<0.001). The liver T2* values measured by CVI42, CMRtools, and Excel are equivalent. The LIC measured by CVI42, CMRtools, and Excel is equivalent to the LICF.

Left Ventricular Function and Iron Loading Status in a Tertiary Center Hemochromatosis Cohort-A Cardiac Magnetic Resonance Study.

Haemochromatosis (HCH), a common genetic disorder with variable penetrance, results in progressive but understudied iron overload. We prospectively evaluated organ iron loading and cardiac function in a tertiary center HCH cohort. 42 HCH patients (47 ± 14 years) and 36 controls underwent laboratory workup and cardiac magnetic resonance (CMR), including T1 and T2* mapping. Myocardial T2* (myoT2*), myocardial T1 (myoT1) and liver T2* (livT2*) were lower in patients compared to controls (33 ± 4 ms vs. 36 ± 3 ms [p = 0.004], 964 ± 33 ms vs. 979 ± 25 ms [p = 0.028] and 21 ± 10 ms vs. 30 ± 5 ms [p &lt; 0.001], respectively). MyoT2* did not reach the threshold of clinically significant iron overload (&lt;20 ms), in any of the patients. In 22 (52.4%) patients, at least one of the tissue parameters was reduced. Reduced myocardial T2* and/or T1 were found in 10 (23.8%) patients, including 4 pts with normal livT2*. LivT2* was reduced in 18 (42.9%) patients. MyoT1 and livT2* inversely correlated with ferritin (rs = -0.351 [p = 0.028] and rs = -0.602 [p &lt; 0.001], respectively). LivT2* by a dedicated sequence and livT2* by cardiac T2* mapping showed good agreement (ICC = 0.876 p &lt; 0.001). In contemporary hemochromatosis, significant myocardial iron overload is rare. Low myocardial T2* and/or T1 values may warrant closer follow-up for accelerated myocardial iron overload even in patients without overt liver overload. Cardiac T2* mapping sequence allows for liver screening at the time of CMR.

Liver T1/T2 values with cardiac MRI during respiration.

Assessing the hepatic status of children with CHD is very important in the post-operative period. This study aimed to assess the usefulness of paediatric liver T1/T2 values and to evaluate the impact of respiration on liver T1/T2 values. Liver T1/T2 values were evaluated in 69 individuals who underwent cardiac MRI. The mean age of the participants was 16.2 ± 9.8 years. Two types of imaging with different breathing methods were possible in 34 participants for liver T1 values and 10 participants for liver T2 values. The normal range was set at 620-830 msec for liver T1 and 25-40 ms for liver T2 based on the data obtained from 17 healthy individuals. The liver T1/T2 values were not significantly different between breath-hold and free-breath imaging (T1: 769.4 ± 102.8 ms versus 763.2 ± 93.9 ms; p = 0.148, T2: 34.9 ± 4.0 ms versus 33.6 ± 2.4 ms; p = 0.169). Higher liver T1 values were observed in patients who had undergone Fontan operation, tetralogy of Fallot operation, or those with chronic viral hepatitis. There was a trend toward correlation between liver T1 values and liver stiffness (R = 0.65, p = 0.0004); and the liver T1 values showed a positive correlation with the shear wave velocity (R = 0.62, p = 0.0006). Liver T1/T2 values were not affected by breathing patterns. Because liver T1 values tend to increase with right heart overload, evaluation of liver T1 values during routine cardiac MRI may enable early detection of future complications.

Variability of noninvasive MRI and biological markers in compensated cirrhosis: insights for assessing disease progression

BackgroundWe annually monitored stable compensated cirrhosis (CC) patients to evaluate serial variation in blood serum, liver stiffness, and multiparametric magnetic resonance imaging (mpMRI) measures to provide reference change values (RCV) and sample size measures for future studies.MethodsPatients were recruited from a prospectively followed CC cohort, with assessments at baseline and annually over three years. We report on blood markers, transient elastography liver stiffness measures (LSM) and noninvasive mpMRI (volume, T1 mapping, blood flow, perfusion) of the liver, spleen, kidneys, and heart in a stable CC group and a healthy volunteer (HV) group. Coefficient of variation over time (CoVT) and RCV are reported, along with hazard ratio to assess disease progression. Sample size estimates to power future trials of cirrhosis regression on mpMRI are presented.ResultsOf 60 CC patients enrolled, 28 with stable CC were followed longitudinally and compared to 10 HVs. CoVT in mpMRI measures was comparable between CC and HV groups. CoVT of Enhanced Liver Fibrosis score was low (< 5%) compared to Fibrosis-4 index (17.9%) and Aspartate Aminotransferase-to-Platelet-Ratio Index (19.4%). A large CoVT (20.7%) and RCV (48.3%) were observed for LSM. CoVT and RCV were low for liver, spleen, and renal T1 values (CoVT < 5%, RCV < 8%) and volume (CoVT < 10%, RCV < 16%); haemodynamic measures were high (CoVT 12–25%, RCV 16–47%).ConclusionsEvidence of low CoVT and RCV in multiorgan T1 values. RCV and sample size estimates are provided for future longitudinal multiorgan monitoring in CC patients.Trial registrationClinicalTrials.gov identifier: NCT02037867, Registered: 05/01/2013.

Multi-parametric magnetic resonance imaging of liver regeneration in a standardized partial hepatectomy rat model

BackgroundWe aimed to evaluate the correlation between the pathological changes and multi-parameter MRI characteristics of liver regeneration (LR) in a standard partial hepatectomy (PH) rat model.MethodsSeventy Sprague–Dawley rats were randomly divided into two groups: MR scan group (n = 14) and pathologic analysis (PA) group (n = 56). All 14 rats in the MR group underwent liver T1 mapping, T2 mapping, and diffusion kurtosis imaging before and the 1st, 2nd, 3rd, 5th, 7th, 14th, and 21st day after 70% hepatectomy. Seven rats in the PA group were euthanized at each time point to determine Ki-67 indices, hepatocyte size (HTS), steatosis grade, and inflammation score.ResultsLiver T1 and T2 values increased to maximum on day 2 (P < 0.001 vs. baseline), D and K values decreased to minimum on day 3 and 2, respectively (P < 0.001 vs. baseline), then all parameters returned to baseline gradually. Hepatocyte Ki-67, hepatocyte size, steatosis grade, and inflammation score initially increased after surgery (P < 0.05 vs. baseline), followed by a gradual decline over time. Both T2 and K values correlated well with Ki-67 indices (r = 0.765 and − 0.807, respectively; both P < 0.001), inflammation (r = 0.809 and − 0.724, respectively; both P < 0.001), steatosis grade (r = 0.814 and − 0.725, respectively; both P < 0.001), and HTS (r = 0.830 and − 0.615, respectively; both P < 0.001).ConclusionsPH induced liver changes that can be observed on MRI. The MRI parameters correlate with the LR activity and allow monitoring of LR process.

Association of heart failure and liver T1 mapping in cardiac magnetic resonance imaging

Abstract Background Heart failure culminates in liver congestion. As the liver can be assessed by cardiac magnetic resonance T1 mapping sequences, it represents a promising imaging biomarker for heart failure. Objectives To evaluate the association between heart failure and magnetic resonance liver T1 mapping, as a non-invasive imaging surrogate of liver congestion. Methods Patients with cardiac magnetic resonance including T1 mapping sequences on a single 1.5T scanner were consecutively included between 01/2017 and 12/2019. Liver T1 was measured in the left lobe, right lobe and caudate lobe on short axis view and in the liver dome on four chamber view. Echocardiographic and laboratory parameters were analyzed within 90 days of the cardiac magnetic resonance exam. Left ventricular filling pressures were assessed according to the European Association of Cardiovascular Imaging guidelines [1]. Liver T1 and echocardiographic parameters were compared between patients with and without elevated NT-proBNP levels (&amp;gt;125 pg/ml) using a Mann-Whitney U test. A multivariate logistic regression model was used to correct for age, sex, body mass index, left ventricular ejection fraction and the presence of atrial fibrillation. Results A total of 397 patients were included (median age 56, 127 females), of whom 138 patients (35%) presented with elevated NT-proBNP levels. Patients with elevated NT-proBNP levels had a larger indexed end-diastolic left ventricular volume (92 vs. 81 ml/m2, p&amp;lt;0.001), lower left ventricular ejection fraction (60 vs. 50%, p&amp;lt;0.001) and a higher E/E' ratio (11 vs. 8, p&amp;lt;0.001). Liver T1 was higher in patients with elevated NT-proBNP in the right liver lobe (670 vs. 596 ms, p&amp;lt;0.001) and the caudate lobe (664 vs. 598 ms, p&amp;lt;0.001), but not in the left liver lobe (571 vs. 568 ms, p=0.068) and in the liver dome (590 vs. 560 ms, p=0.1). Echocardiographic evaluation showed similar results with significant difference in T1 times between patients with elevated and non-elevated left ventricular filling pressures in caudate and right liver lobe. Liver T1 retained its predictive value when corrected for age, left ventricular ejection fraction and the presence of atrial fibrillation, when measured in the caudate lobe (adjusted odds ratio 1.013, 95% confidence interval 1.004–1.023, p=0.005) and in the right lobe (adjusted odds ratio 1.012, 95% confidence interval 1.003–1.021, p=0.009). Conclusions Elevated liver T1 in cardiac magnetic resonance imaging is associated with heart failure and represents an independent non-invasive imaging surrogate for liver congestion. Funding Acknowledgement Type of funding sources: None.

Is serum ferritin level or T2-sequence magnetic resonance imaging more effective in predicting liver iron in transfusion-dependent thalassemia cases?

Amaç: Transfüzyon bağımlı talasemi hastalarında aşırı demir yüklenmesi, sürekli şelasyon tedavisi ve demir düzeyi izlemini gerektiren bir durumdur. Serum ferritin düzeyinin tayini, demir yükünü takip etmek için basit bir yöntem olarak kabul edilmektedir. Bununla birlikte, karaciğer demir düzeyi tayininde manyetik rezonans görüntüleme (MRG) gibi yöntemlerin daha kesin olduğunu vurgulamaktadır.&#x0D; Gereç ve Yöntem: Talasemide demir yükünün anlaşılmasına katkıda bulunmak amacıyla, kök hücre transfüzyonuna hazırlık amacıyla karaciğer biyopsisi yapılan 14 transfüzyon bağımlı talasemi hastasının karaciğer demir düzeyi sonuçlarını karaciğer T2 MRG ve serum ferritin sonuçları ile karşılaştırıldı.&#x0D; Bulgular: Serum ferritin değeri ortalaması 2488,43±1520,18 mg/L idi. T2*MRG sonuçlarına göre karaciğer demir yükü değerlendirildiğinde sekiz hastada hafif düzey, beş hastada orta düzey, bir hastada ileri düzey demir birikimi saptandı. Modifiye Scheuer sınıflamasına göre biyopsilerde demir düzeyi iki hastada derece 1; yedi hastada derece 2; üç hastada derece 3 ve iki hastada derece 4 olarak değerlendirildi. Ferritin düzeyi arttıkça karaciğer demir biyopsi skoru da istatistiksel anlamlı olarak artmaktaydı (r=0,544 ve p=0,044). Karaciğer T2 MRG düzeyi ile karaciğer demir biyopsi skoru arasında ise istatistiksel olarak anlamlı ve ters yönlü korelasyon mevcuttu (r=-0,724 ve p=0,003). Karaciğer biyopsi demir skoruna göre demir düzeyini ayırt etmede ferritin düzeyi istatistiksel olarak anlamlı bulunmazken (p=0,096); T2*MRG ölçümlerine ilişkin ROC eğrisi altında kalan alan istatistiksel olarak anlamlı bulundu (AUC=0,967; 95% CI: 0,880-1,000 ve p=0,005).&#x0D; Sonuç: Çalışmamızda serum ferritin ve T2 MRG sonuçlarının karaciğer biyopsisi demir düzeyi ile korele olduğunu saptadık. Ancak ferritin düzeyinin karaciğer biyopsisi demir düzeyini göstermede sensitivite ve spesifitesinin düşük olduğu, T2 MRG ise sensitivite ve spesifitesinin yüksek olduğunu saptadık.

Quantitative T2* MRI for bone marrow iron overload: normal reference values and assessment in thalassemia major patients.

We evaluated the feasibility and reproducibility of bone marrow T2* values and established the lower limit of normal in a cohort of healthy subjects. We investigated the clinical correlates of bone marrow T2* values in patients with thalassemia major (TM). Thirty healthy subjects and 274 consecutive TM patients (38.96 ± 8.49years, 151 females) underwent MRI at 1.5T. An axial slice in the upper abdomen was acquired by a T2* gradient-echo multiecho sequence and the T2* value was calculated in a circular region of interest defined in the visible body of the first or second lumbar vertebra. In patients, also liver and heart T2* values were assessed. In healthy subjects bone marrow T2* values were independent of age and gender. The lower limit of normal for bone marrow T2* was 13ms. In both healthy subjects and 30 randomly selected patients, the coefficient of variation for inter-operator-reproducibility was < 10%. TM patients exhibited significantly lower bone marrow T2* values than healthy subjects (7.47 ± 5.18ms vs. 17.08 ± 1.89ms; p < 0.0001). A pathological bone marrow T2* was detected in 82.8% of TM patients. In TM, the female sex was associated with reduced bone marrow T2* values. Bone marrow T2* values were inversely correlated with mean serum ferritin levels (R = -0.431; P < 0.0001) and hepatic iron load (R = -0.215; P < 0.0001). A serum ferritin level > 536ng/ml predicted the presence of a pathological bone marrow T2*. A positive correlation was found between bone marrow and heart T2* values (R = 0.143; P = 0.018). A normal bone marrow T2* showed a negative predictive value of 100% for cardiac iron. Bone marrow T2* measurements can be easily obtained using the same sequences acquired for liver iron quantification and may bring new insights into the pathophysiology of iron deposition; hence, they should be incorporated into clinical practice.

Performance of native and gadoxetate-enhanced liver and spleen T1 mapping for noninvasive diagnosis of clinically significant portal hypertension: preliminary results.

In this preliminary study, our aim was to assess the utility of quantitative native-T1 (T1-pre), iron-corrected T1 (cT1) of the liver/spleen and T1 mapping of the liver obtained during hepatobiliary phase (T1-HBP) post-gadoxetate disodium, compared to spleen size/volume and APRI (aspartate aminotransferase-to-platelet ratio index) for noninvasive diagnosis of clinically significant portal hypertension [CSPH, defined as hepatic venous pressure gradient (HVPG) ≥ 10mm Hg]. Forty-nine patients (M/F: 27/22, mean age 53y) with chronic liver disease, HVPG measurement and MRI were included. Breath-held T1 and cT1 measurements were obtained using an inversion recovery Look-Locker sequence and a T2* corrected modified Look-Locker sequence, respectively. Liver T1-pre (n = 49), spleen T1 (obtained pre-contrast, n = 47), liver and spleen cT1 (both obtained pre-contrast, n = 30), liver T1-HBP (obtained 20min post gadoxetate disodium injection, n = 36) and liver T1 uptake (ΔT1, n = 36) were measured. Spleen size/volume and APRI were also obtained. Spearmancorrelation coefficients were used to assess the correlation between each of liver/spleen T1/cT1 parameters, spleen size/volume and APRI with HVPG. ROC analysis was performed to determine the performance ofmeasured parametersfor diagnosis of CSPH. There were 12/49 (24%) patients with CSPH. Liver T1-pre (r = 0.287, p = 0.045), liver T1-HBP (r = 0.543, p = 0.001), liver ΔT1 (r = - 0.437, p = 0.008), spleen T1 (r = 0.311, p = 0.033) and APRI (r = 0.394, p = 0.005) were all significantly correlated with HVPG, while liver cT1, spleen cT1 and spleen size/volume were not. The highest AUCs for the diagnosis of CSPH were achieved with liver T1-HBP, liver ΔT1 and spleen T1: 0.881 (95%CI 0.76-1.0, p = 0.001), 0.852 (0.72-0.98, p = 0.002) and 0.781 (0.60-0.95, p = 0.004), respectively. Our preliminary results demonstrate the potential of liver T1 mapping obtained during HBP post gadoxetate disodium for the diagnosis of CSPH. These results require further validation.