Magnetic Resonance Elastography Methods Research Articles

Test-retest reliability and follow-up of muscle magnetic resonance elastography in adults with and without muscle diseases.

We investigated the potential of magnetic resonance elastography (MRE) stiffness measurements in skeletal muscles as an outcome measure, by determining its test-retest reliability, as well as its sensitivity to change in a longitudinal follow-up study. We assessed test-retest reliability of muscle MRE in 20 subjects with (n=5) and without (n=15) muscle diseases and compared this to Dixon proton density fat fraction (PDFF) and volume measurements. Next, we measured MRE muscle stiffness in 21 adults with Becker muscular dystrophy (BMD) and 21 age-matched healthy controls at baseline, and after 9 and 18months. We compared two different methods of analysing MRE data in this study: 'Method A' used the stiffness maps generated by the Philips MRE software, and 'Method B' applied a custom-made procedure based on wavelength measurements on the MRE images. Intraclass correlation coefficients (ICC) of muscle stiffness ranged from good (0.83 for left vastus medialis, P<0.001) to poor (0.19 for right rectus femoris, P=0.212) for the examined thigh muscles with Method A, but we did not find a significant test-retest reliability with Method B (P>0.050 for all). The ICC of muscle PDFF and volume measurements was excellent (>0.90; P<0.001) for all muscles. At baseline, the average stiffness of all thigh muscles was significantly lower in adults with BMD than in controls for both Method A (-0.2kPa, P=0.025) and Method B (-0.6kPa, P<0.001). Regardless of which method was used, there was no significant difference in the evolution of muscle stiffness in patients and controls over 18months. Test-retest reliability of muscle MRE using a simple 2D technique was suboptimal, and did not reliably measure muscle stiffness changes in adults with BMD as compared with controls over 18months. While the results provide motivation for testing more advanced 3D MRE methods, we conclude that the simple 2D MRE implementation used in this study is not suitable as an outcome measure for characterizing thigh muscle in clinical trials.

Viscoelastic polyacrylamide MR elastography phantoms with tunable damping ratio independent of shear stiffness

Physiologically modeled test samples with known properties and characteristics, or phantoms, are essential for developing sensitive, repeatable, and accurate quantitative MRI techniques. Magnetic resonance elastography (MRE) is one such technique used to estimate tissue mechanical properties, and it is advantageous to use phantoms with independently tunable mechanical properties to benchmark the accuracy of MRE methods. Phantoms with tunable shear stiffness are commonly used for MRE, but tuning the viscosity or damping ratio has proven to be difficult. A promising candidate for MRE phantoms with tunable damping ratio is polyacrylamide (PAA). While pure PAA has very low attenuation, viscoelastic hydrogels have been made by entrapping linear polyacrylamide strands (LPAA) within the PAA network. In this study, we evaluate the use of LPAA/PAA gels as physiologically accurate phantoms with tunable damping ratio, independent of shear stiffness, via MRE. Phantoms were made with 15.3 wt% PAA while the LPAA concentration ranged from 4.5 wt% to 8.0 wt%. MRE was performed at 9.4 T with 400 Hz vibration on all phantoms revealing a strong, positive correlation between damping ratio and LPAA content (p < 0.001). There was no significant correlation between shear stiffness and LPAA content, confirming a constant PAA concentration yielded constant shear stiffness. Rheometry at 10 Hz was performed to verify the damping ratio of the phantoms. Nearly identical slopes for damping ratio versus LPAA content were found from both MRE and rheometry (0.0073 and 0.0075 respectively). Ultimately, this study validates the adaptation of polyacrylamide gels into physiologically-relevant MRE phantoms to enable testing of MRE estimates of damping ratio.

Technical Success and Reliability of Magnetic Resonance Elastography in Patients with Hepatic Iron Overload

This study aimed to evaluate the technical success rate and stiffness measurement reliability of two specific hepatic magnetic resonance elastography (MRE) sequences dedicated to solving susceptibility artifacts in patients with various degrees of hepatic iron overload. Thirty-seven patients with iron-overloaded liver confirmed by R2* value measurement who underwent two-dimensional (2D) spin-echo (SE) MRE and 2D SE-echo-planar-imaging (EPI) MRE were reviewed retrospectively. According to four categories based on R2* value (mild, moderate, severe elevation, and extremely severe iron overload), we compared the success rate, quality score, and liver stiffness of the two sequences. In addition, Spearman's correlation was performed to evaluate the relationship between the R2* value and liver stiffness. The overall success rates of SE MRE and SE-EPI MRE in patients with hepatic iron overload were 91.89% and 78.38%, respectively, and 100% and 78.57%, respectively, for severe elevation iron overload. In all patients, the MRE quality scores were 54 and 48 for SE MRE and SE-EPI MRE, respectively (P=0.107). There were no significant differences in liver stiffness measurements between the two MRE methods in patients with mild, moderate, and severe elevation iron-overloaded livers (P>0.6 for all), respectively. For both MRE methods, R2* value had no significant effect on the liver stiffness measurements (correlation coefficient <0.1, P >0.6 for both). In the mild and moderate elevation iron-overloaded liver, both SE MRE and fast SE-EPI MRE can provide successful and reliable liver stiffness measurement. In severe elevation iron-overloaded livers, SE MRE may be a better choice than SE-EPI MRE.

In vivo estimation of anisotropic mechanical properties of the gastrocnemius during functional loading with MR elastography

Objective. In vivo imaging assessments of skeletal muscle structure and function allow for longitudinal quantification of tissue health. Magnetic resonance elastography (MRE) non-invasively quantifies tissue mechanical properties, allowing for evaluation of skeletal muscle biomechanics in response to loading, creating a better understanding of muscle functional health. Approach. In this study, we analyze the anisotropic mechanical response of calf muscles using MRE with a transversely isotropic, nonlinear inversion algorithm (TI-NLI) to investigate the role of muscle fiber stiffening under load. We estimate anisotropic material parameters including fiber shear stiffness (), substrate shear stiffness (), shear anisotropy (), and tensile anisotropy () of the gastrocnemius muscle in response to both passive and active tension. Main results. In passive tension, we found a significant increase in and with increasing muscle length. While in active tension, we observed increasing and decreasing and during active dorsiflexion and plantarflexion—indicating less anisotropy—with greater effects when the muscles act as agonist. Significance. The study demonstrates the ability of this anisotropic MRE method to capture the multifaceted mechanical response of skeletal muscle to tissue loading from muscle lengthening and contraction.

Structure-Function Dissociations of Human Hippocampal Subfield Stiffness and Memory Performance.

Aging and neurodegenerative diseases lead to decline in thinking and memory ability. The subfields of the hippocampus (HCsf) play important roles in memory formation and recall. Imaging techniques sensitive to the underlying HCsf tissue microstructure can reveal unique structure-function associations and their vulnerability in aging and disease. The goal of this study was to use magnetic resonance elastography (MRE), a noninvasive MR imaging-based technique that can quantitatively image the viscoelastic mechanical properties of tissue to determine the associations of HCsf stiffness with different cognitive domains across the lifespan. Eighty-eight adult participants completed the study (age 23-81 years, male/female 36/51), in which we aimed to determine which HCsf regions most strongly correlated with different memory performance outcomes and if viscoelasticity of specific HCsf regions mediated the relationship between age and performance. Our results revealed that both interference cost on a verbal memory task and relational memory task performance were significantly related to cornu ammonis 1-2 (CA1-CA2) stiffness (p = 0.018 and p = 0.011, respectively), with CA1-CA2 stiffness significantly mediating the relationship between age and interference cost performance (p = 0.031). There were also significant associations between delayed free verbal recall performance and stiffness of both the dentate gyrus-cornu ammonis 3 (DG-CA3; p = 0.016) and subiculum (SUB; p = 0.032) regions. This further exemplifies the functional specialization of HCsf in declarative memory and the potential use of MRE measures as clinical biomarkers in assessing brain health in aging and disease.SIGNIFICANCE STATEMENT Hippocampal subfields are cytoarchitecturally unique structures involved in distinct aspects of memory processing. Magnetic resonance elastography is a technique that can noninvasively image tissue viscoelastic mechanical properties, potentially serving as sensitive biomarkers of aging and neurodegeneration related to functional outcomes. High-resolution in vivo imaging has invigorated interest in determining subfield functional specialization and their differential vulnerability in aging and disease. Applying MRE to probe subfield-specific cognitive correlates will indicate that measures of subfield stiffness can determine the integrity of structures supporting specific domains of memory performance. These findings will further validate our high-resolution MRE method and support the potential use of subfield stiffness measures as clinical biomarkers in classifying aging and disease states.

Mapping heterogenous anisotropic tissue mechanical properties with transverse isotropic nonlinear inversion MR elastography.

The white matter tracts of brain tissue consist of highly-aligned, myelinated fibers; white matter is structurally anisotropic and is expected to exhibit anisotropic mechanical behavior. In vivo mechanical properties of tissue can be imaged using magnetic resonance elastography (MRE). MRE can detect and monitor natural and disease processes that affect tissue structure; however, most MRE inversion algorithms assume locally homogenous properties and/or isotropic behavior, which can cause artifacts in white matter regions. A heterogeneous, model-based transverse isotropic implementation of a subzone-based nonlinear inversion (TI-NLI) is demonstrated. TI-NLI reconstructs accurate maps of the shear modulus, damping ratio, shear anisotropy, and tensile anisotropy of in vivo brain tissue using standard MRE motion measurements and fiber directions estimated from diffusion tensor imaging (DTI). TI-NLI accuracy was investigated with using synthetic data in both controlled and realistic settings: excellent quantitative and spatial accuracy was observed and cross-talk between estimated parameters was minimal. Ten repeated, in vivo, MRE scans acquired from a healthy subject were co-registered to demonstrate repeatability of the technique. Good resolution of anatomical structures and bilateral symmetry were evident in MRE images of all mechanical property types. Repeatability was similar to isotropic MRE methods and well within the limits required for clinical success. TI-NLI MRE is a promising new technique for clinical research into anisotropic tissues such as the brain and muscle.

Short echo time dual-frequency MR Elastography with Optimal Control RF pulses

Magnetic Resonance Elastography (MRE) quantifies the mechanical properties of tissues, typically applying motion encoding gradients (MEG). Multifrequency results allow better characterizations of tissues using data usually acquired through sequential monofrequency experiments. High frequencies are difficult to reach due to slew rate limitations and low frequencies induce long TEs, yielding magnitude images with low SNR. We propose a novel strategy to perform simultaneous multifrequency MRE in the absence of MEGs: using RF pulses designed via the Optimal Control (OC) theory. Such pulses control the spatial distribution of the MRI magnetization phase so that the resulting transverse magnetization reproduces the phase pattern of an MRE acquisition. The pulse is applied with a constant gradient during the multifrequency mechanical excitation to simultaneously achieve slice selection and motion encoding. The phase offset sampling strategy can be adapted according to the excitation frequencies to reduce the acquisition time. Phantom experiments were run to compare the classical monofrequency MRE to the OC based dual-frequency MRE method and showed excellent agreement between the reconstructed shear storage modulus G′. Our method could be applied to simultaneously acquire low and high frequency components, which are difficult to encode with the classical MEG MRE strategy.

Harmonic wideband simultaneous dual-frequency MR Elastography.

Magnetic resonance elastography (MRE) is used to non-invasively quantify viscoelastic properties of tissues based on the measurement of propagation characteristics of shear waves. Because some of these viscoelastic parameters show a frequency dependence, multifrequency analysis allows us to measure the wave propagation dispersion, leading to a better characterization of tissue properties. Conventionally, motion encoding gradients (MEGs) oscillating at the same frequency as the mechanical excitation encode motion. Hence, multifrequency data is usually obtained by sequentially repeating monochromatic wave excitations experiments at different frequencies. The result is that the total acquisition time is multiplied by a factor corresponding to the number of repetitions of monofrequency experiments, which is a major limitation of multifrequency MRE. In order to make it more accessible, a novel single-shot harmonic wideband dual-frequency MRE method is proposed. Two superposed shear waves of different frequencies are simultaneously generated and propagate in a sample. Trapezoidal oscillating MEGs are used to encode mechanical vibrations having frequencies that are an odd multiple of the MEG frequency. The number of phase offsets is optimized to reduce the acquisition time. For this purpose, a sampling method not respecting the Shannon theorem is used to produce a controlled temporal aliasing that allows us to encode both frequencies without any additional examination time. Phantom experiments were run to compare conventional monofrequency MRE with the single-shot dual-frequency MRE method and showed excellent agreement between the reconstructed shear storage moduli G'. In addition, dual-frequency MRE yielded an increased signal-to-noise ratio compared with conventional monofrequency MRE acquisitions when encoding the high frequency component. The novel proposed multifrequency MRE method could be applied to simultaneously acquire more than two frequency components, reducing examination time. Further studies are needed to confirm its applicability in preclinical and clinical models.

An analytical solution to the dispersion-by-inversion problem in magnetic resonance elastography.

Magnetic resonance elastography (MRE) measures stiffness of soft tissues by analyzing their spatial harmonic response to externally induced shear vibrations. Many MRE methods use inversion-based reconstruction approaches, which invoke first- or second-order derivatives by finite difference operators (first- and second-FDOs) and thus give rise to a biased frequency dispersion of stiffness estimates. We here demonstrate analytically, numerically, and experimentally that FDO-based stiffness estimates are affected by (1) noise-related underestimation of values in the range of high spatial wave support, that is, at lower vibration frequencies, and (2) overestimation of values due to wave discretization at low spatial support, that is, at higher vibration frequencies. Our results further demonstrate that second-FDOs are more susceptible to noise than first-FDOs and that FDO dispersion depends both on signal-to-noise ratio (SNR) and on a lumped parameter A, which is defined as wavelength over pixel size and over a number of pixels per stencil of the FDO. Analytical FDO dispersion functions are derived for optimizing A parameters at a given SNR. As a simple rule of thumb, we show that FDO artifacts are minimized when A/2 is in the range of the square root of 2SNR for the first-FDO or cubic root of 5SNR for the second-FDO. Taken together, the results of our study provide an analytical solution to a long-standing, well-recognized, yet unsolved problem in MRE postprocessing and might thus contribute to the ongoing quest for minimizing inversion artifacts in MRE.

Mechanical property alterations across the cerebral cortex due to Alzheimer's disease.

Alzheimer’s disease is a personally devastating neurodegenerative disorder and a major public health concern. There is an urgent need for medical imaging techniques that better characterize the early stages and monitor the progression of the disease. Magnetic resonance elastography (MRE) is a relatively new and highly sensitive MRI technique that can non-invasively assess tissue microstructural integrity via measurement of brain viscoelastic mechanical properties. For the first time, we use high-resolution MRE methods to conduct a voxel-wise MRE investigation and state-of-the-art post hoc region of interest analysis of the viscoelastic properties of the cerebral cortex in patients with Alzheimer’s disease (N = 11) compared with cognitively healthy older adults (N = 12). We replicated previous findings that have reported significant volume and stiffness reductions at the whole-brain level. Significant reductions in volume were also observed in Alzheimer’s disease when white matter, cortical grey matter and subcortical grey matter compartments were considered separately; lower stiffness was also observed in white matter and cortical grey matter, but not in subcortical grey matter. Voxel-based morphometry of both cortical and subcortical grey matter revealed localized reductions in volume due to Alzheimer’s disease in the hippocampus, fusiform, middle, superior temporal gyri and precuneus. Similarly, voxel-based MRE identified lower stiffness in the middle and superior temporal gyri and precuneus, although the spatial distribution of these effects was not identical to the pattern of volume reduction. Notably, MRE additionally identified stiffness deficits in the operculum and precentral gyrus located within the frontal lobe; regions that did not undergo volume loss identified through voxel-based morphometry. Voxel-based-morphometry and voxel-based MRE results were confirmed by a complementary post hoc region-of-interest approach in native space where the viscoelastic changes remained significant even after statistically controlling for regional volumes. The pattern of reduction in cortical stiffness observed in Alzheimer’s disease patients raises the possibility that MRE may provide unique insights regarding the neural mechanisms which underlie the development and progression of the disease. The measured mechanical property changes that we have observed warrant further exploration to investigate the diagnostic usefulness of MRE in cases of Alzheimer’s disease and other dementias.

MR elastography to measure the effects of cancer and pathology fixation on prostate biomechanics, and comparison with T1, T2 and ADC

MRI is under evaluation for image-guided intervention for prostate cancer. The sensitivity and specificity of MRI parameters is determined via correlation with the gold-standard of histopathology. Whole-mount histopathology of prostatectomy specimens can be digitally registered to in vivo imaging for correlation. When biomechanical-based deformable registration is employed to account for deformation during histopathology processing, the ex vivo biomechanical properties are required. However, these properties are altered by pathology fixation, and vary with disease. Hence, this study employs magnetic resonance elastography (MRE) to measure ex vivo prostate biomechanical properties before and after fixation.A quasi-static MRE method was employed to measure high resolution maps of Young’s modulus (E) before and after fixation of canine prostate and prostatectomy specimens (n = 4) from prostate cancer patients who had previously received radiation therapy. For comparison, T1, T2 and apparent diffusion coefficient (ADC) were measured in parallel.E (kPa) varied across clinical anatomy and for histopathology-identified tumor: peripheral zone: 99(±22), central gland: 48(±37), tumor: 85(±53), and increased consistently with fixation (factor of 11 ± 5; p < 0.02). T2 decreased consistently with fixation, while changes in T1 and ADC were more complex and inconsistent.The biomechanics of the clinical prostate specimens varied greatly with fixation, and to a lesser extent with disease and anatomy. The data obtained will improve the precision of prostate pathology correlation, leading to more accurate disease detection and targeting.

K-space data processing for magnetic resonance elastography (MRE).

Magnetic resonance elastography (MRE) requires substantial data processing based on phase image reconstruction, wave enhancement, and inverse problem solving. The objective of this study is to propose a new, fast MRE method based on MR raw data processing, particularly adapted to applications requiring fast MRE measurement or high elastogram update rate. The proposed method allows measuring tissue elasticity directly from raw data without prior phase image reconstruction and without phase unwrapping. Experimental feasibility is assessed both in a gelatin phantom and in the liver of a porcine model in vivo. Elastograms are reconstructed with the raw MRE method and compared to those obtained using conventional MRE. In a third experiment, changes in elasticity are monitored in real-time in a gelatin phantom during its solidification by using both conventional MRE and raw MRE. The raw MRE method shows promising results by providing similar elasticity values to the ones obtained with conventional MRE methods while decreasing the number of processing steps and circumventing the delicate step of phase unwrapping. Limitations of the proposed method are the influence of the magnitude on the elastogram and the requirement for a minimum number of phase offsets. This study demonstrates the feasibility of directly reconstructing elastograms from raw data.

An automatic differentiation-based gradient method for inversion of the shear wave equation in magnetic resonance elastography: specific application in fibrous soft tissues

Quantitative and accurate measurement of in vivo mechanical properties using dynamic elastography has been the scope of many research efforts over the past two decades. Most of the shear-wave-based inverse approaches for magnetic resonance elastography (MRE) make the assumption of isotropic viscoelasticity. In this paper, we propose a quantitative gradient method for inversion of the shear wave equation in anisotropic media derived from a full waveform description using analytical viscoelastic Green formalism and automatic differentiation. The abilities and performances of the proposed identification method are first evaluated on numerical phantoms calculated in a transversely isotropic medium, and subsequently on experimental MRE data measured on an isotropic hydrogel phantom, on an anisotropic cryogel phantom and on an ex vivo fibrous muscle. The experiments are carried out by coupling circular shear wave profiles generated by acoustic radiation force and MRE acquisition of the wave front. Shear modulus values obtained by our MRE method are compared to those obtained by rheometry in the isotropic hydrogel phantom, and are found to be in good agreement despite non-overlapping frequency ranges. Both the cryogel and the ex vivo muscle are found to be anisotropic. Stiffness values in the longitudinal direction are found to be 1.8 times and 1.9 times higher than those in the transverse direction for the cryogel and the muscle, respectively. The proposed method shows great perspectives and substantial benefits for the in vivo quantitative investigation of complex mechanical properties in fibrous soft tissues.

Medial temporal lobe viscoelasticity and relational memory performance

Structural and functional imaging studies have been among converging lines of evidence demonstrating the importance of the hippocampus in successful memory performance. The advent of a novel neuroimaging technique – magnetic resonance elastography (MRE) – now makes it possible for us to investigate the relationship between the microstructural integrity of hippocampal tissue and successful memory processing. Mechanical properties of brain tissue estimated with MRE provide a measure of the integrity of the underlying tissue microstructure and have proven to be sensitive measures of tissue health in neurodegeneration. However, until recently, MRE methods lacked sufficient resolution necessary to accurately examine specific neuroanatomical structures in the brain, and thus could not contribute to examination of specific structure–function relationships. In this study, we took advantage of recent developments in MRE spatial resolution and mechanical inversion techniques to measure the viscoelastic properties of the human hippocampus in vivo, and investigated how these properties reflect hippocampal function. Our data reveal a strong relationship between relative elastic/viscous behavior of the hippocampus and relational memory performance (N=20). This is the first report linking the mechanical properties of brain tissue with functional performance.

Concurrent 3D acquisition of diffusion tensor imaging and magnetic resonance elastography displacement data (DTI-MRE): Theory and in vivo application.

To introduce a newly developed technique (DTI-MRE) for the simultaneous acquisition of diffusion tensor imaging (DTI) and 3D-vector field magnetic resonance elastography (MRE) data, and to demonstrate its feasibility when applied in vivo to the mouse brain. In DTI-MRE, simultaneous encoding is achieved by using a series of diffusion/motion-sensitizing gradients (dMSGs) with specific timing and directions. By adjusting the duration of the dMSGs with the diffusion time and with the mechanical vibration frequency, the shear wave motion and diffusion are encoded into the MR phase and MR magnitude signals, respectively. The dMSGs are applied in a noncollinear and noncoplanar manner that optimizes the capture of both the DTI signal attenuation and the three-dimensional MRE displacements. In this work, the feasibility of the DTI-MRE technique was demonstrated on in vivo mouse brains (n=3) using a 9.4T animal MRI scanner. The DTI-MRE derived parameters (MD, mean diffusivity; FA, fractional anisotropy; MRE displacement fields; and shear modulus |G|) were compared with those acquired using conventional, separate MRE and diffusion methods. The averaged (MD, FA, and |G|) values for three mice are (0.580 ± 0.050 µm2 /ms, 0.43 ± 0.02, and 4.80 ± 0.06 kPa) and (0.583 ± 0.035 µm2 /ms, 0.46 ± 0.02, and 4.91 ± 0.19 kPa) for DTI-MRE, and conventional DTI and 3D-vector field MRE measurements, respectively. All derived parameters (MD, FA, |G|, and displacement) obtained using the combined DTI-MRE method and conventional methods were significantly correlated with P < 0.05. Simultaneous acquisition of DTI and 3D-vector field MRE is feasible in vivo and reduces the scan time by up to 50% compared with conventional, separate acquisitions, while providing an immediate co-registration of maps of diffusion properties and stiffness. Magn Reson Med 77:273-284, 2017. © 2016 Wiley Periodicals, Inc.

Magnetic Resonance Imaging More Accurately Classifies Steatosis and Fibrosis in Patients With Nonalcoholic Fatty Liver Disease Than Transient Elastography

Noninvasive methods have been evaluated for the assessment of liver fibrosis and steatosis in patients with nonalcoholic fatty liver disease (NAFLD). We compared the ability of transient elastography (TE) with the M-probe, and magnetic resonance elastography (MRE) to assess liver fibrosis. Findings from magnetic resonance imaging (MRI)-based proton density fat fraction (PDFF) measurements were compared with those from TE-based controlled attenuation parameter (CAP) measurements to assess steatosis. We performed a cross-sectional study of 142 patients with NAFLD (identified by liver biopsy; mean body mass index, 28.1 kg/m(2)) in Japan from July 2013 through April 2015. Our study also included 10 comparable subjects without NAFLD (controls). All study subjects were evaluated by TE (including CAP measurements), MRI using the MRE and PDFF techniques. TE identified patients with fibrosis stage ≥2 with an area under the receiver operating characteristic (AUROC) curve value of 0.82 (95% confidence interval [CI]: 0.74-0.89), whereas MRE identified these patients with an AUROC curve value of 0.91 (95% CI: 0.86-0.96; P= .001). TE-based CAP measurements identified patients with hepatic steatosis grade ≥2 with an AUROC curve value of 0.73 (95% CI: 0.64-0.81) and PDFF methods identified them with an AUROC curve value of 0.90 (95% CI: 0.82-0.97; P < .001). Measurement of serum keratin 18 fragments or alanine aminotransferase did not add value to TE or MRI for identifying nonalcoholic steatohepatitis. MRE and PDFF methods have higher diagnostic performance in noninvasive detection of liver fibrosis and steatosis in patients with NAFLD than TE and CAP methods. MRI-based noninvasive assessment of liver fibrosis and steatosis is a potential alternative to liver biopsy in clinical practice. UMIN Clinical Trials Registry No. UMIN000012757.

Comparing hepatic 2D and 3D magnetic resonance elastography methods in a clinical setting – Initial experiences

PurposeContinuous monitoring of liver fibrosis progression in patients is not feasible with the current diagnostic golden standard (needle biopsy). Recently, magnetic resonance elastography (MRE) has emerged as a promising method for such continuous monitoring. Since there are different MRE methods that could be used in a clinical setting there is a need to investigate whether measurements produced by these MRE methods are comparable. Hence, the purpose of this pilot study was to evaluate whether the measurements of the viscoelastic properties produced by 2D (stiffness) and 3D (elasticity and ‘Gabs,Elastic’) MRE are comparable. Materials and methodsSeven patients with diffuse or suspect diffuse liver disease were examined in the same day with the two MRE methods. 2D MRE was performed using an acoustic passive transducer, with a 1.5T GE 450W MR system. 3D MRE was performed using an electromagnetic active transducer, with a 1.5T Philips Achieva MR system. Finally, mean viscoelastic values were extracted from the same anatomical region for both methods by an experienced radiologist. ResultsStiffness correlated well with the elasticity, R2=0.96 (P<0.001; slope=1.08, intercept=0.61kPa), as well as with ‘Gabs,Elastic’ R2=0.96 (P<0.001; slope=0.95, intercept=0.28kPa). ConclusionThis pilot study shows that different MRE methods can produce comparable measurements of the viscoelastic properties of the liver. The existence of such comparable measurements is important, both from a clinical as well as a research perspective, since it allows for equipment-independent monitoring of disease progression.

TREMR: Table‐resonance elastography with MR

Magnetic resonance elastography (MRE) is a noninvasive method of measuring tissue compliance. Current MRE methods rely on custom-built hardware to elicit vibrations that are tracked by MR imaging. Knowledge of the wave propagation can be used to calculate the local shear stiffness of the tissue. We sought to determine whether the vibrations of the patient table that result from low-frequency switching of the imaging gradients could be used as an alternative mechanical driving mechanism for MRE. We designed a pulse sequence that includes a gradient lobe specifically for the excitation of mechanical resonance, allowing control of the time between the onset of the vibrations and the velocity-encoding of the readout. Data collected from a gelatin phantom with stiff cylindrical gelatin inserts demonstrated that wave propagation can be imaged with this method. Postprocessing to estimate the local spatial frequency of the waves also allows estimation of the local shear stiffness, where the stiff inserts are clearly identifiable. Data collected on the brain of a normal healthy volunteer showed clear rotational waves propagating from the skull inwards, also allowing generation of shear stiffness maps.

Scatter-based magnetic resonance elastography

Elasticity is a sensitive measure of the microstructural constitution of soft biological tissues and increasingly used in diagnostic imaging. Magnetic resonance elastography (MRE) uniquely allows in vivo measurement of the shear elasticity of brain tissue. However, the spatial resolution of MRE is inherently limited as the transformation of shear wave patterns into elasticity maps requires the solution of inverse problems. Therefore, an MRE method is introduced that avoids inversion and instead exploits shear wave scattering at elastic interfaces between anatomical regions of different shear compliance. This compliance-weighted imaging (CWI) method can be used to evaluate the mechanical consistency of cerebral lesions or to measure relative stiffness differences between anatomical subregions of the brain. It is demonstrated that CWI-MRE is sensitive enough to reveal significant elasticity variations within inner brain parenchyma: the caudate nucleus (head) was stiffer than the lentiform nucleus and the thalamus by factors of 1.3 ± 0.1 and 1.7 ± 0.2, respectively (P < 0.001). CWI-MRE provides a unique method for characterizing brain tissue by identifying local stiffness variations.

A theoretical approach to local attenuation measurements of shear waves by MRE. Preliminary experimental results

Abstract An essential highlight of the presented method is the employment of Magnetic Resonance Elastography (MRE) for local measurements of the attenuation of elastic shear waves introduced into a biological sample. Such a measurement can be accomplished by combining the MRE method with those methods, in which collective displacement of spins is induced by external physical factors, such as variable electric field, strong magnetic field gradient or longitudinal elastic wave. A theoretical basis of the method involving external factors and results of preliminary experiments have been presented in this paper.