Magnetic Resonance Elastography Research Articles

A Prospective Study on the Prevalence of MASLD in Patients With Type 2 Diabetes and Hyperferritinaemia.

Elevated levels of serum ferritin, a marker of hepatic iron overload and inflammation, may be associated with metabolic dysfunction-associated steatotic liver disease (MASLD) and hepatic fibrosis. To determine the prevalence of MASLD and significant hepatic fibrosis among patients with type 2 diabetes mellitus (T2DM) and hyperferritinaemia. This is a cross-sectional analysis of a prospective cohort of 523 adults (64% female) aged 50-80 with T2DM and without a diagnosis of haemochromatosis. MASLD and significant fibrosis were defined as magnetic resonance imaging-proton density fat fraction (MRI-PDFF) ≥ 5% and magnetic resonance elastography (MRE) ≥ 3.0 kPa, respectively. Hyperferritinaemia was defined as serum ferritin ≥ 200 ng/mL in females or ≥ 300 ng/mL in males. The primary objective was to determine the prevalence of MASLD and significant fibrosis in hyperferritinaemia. The mean age and body mass index were 64.1 (±8.1) years and 31.5 (±5.9) kg/m2, respectively. The overall prevalence of hyperferritinaemia was 20.5% (n = 107). The prevalence of MASLD (78.5% vs. 62.1%, p = 0.001) and significant fibrosis (35.5% vs. 22.1%, p = 0.002) were higher in participants with hyperferritinaemia than those without. Hyperferritinaemia remained an independent predictor of MASLD (OR 2.01; 95% CI 1.19-3.39; p = 0.009) and significant fibrosis (OR 2.33; CI 1.43-3.77; p = 0.001), even after adjustment for age, sex, obesity and insulin use. Approximately 80% of people with hyperferritinaemia and T2DM have MASLD, and more than a third have significant hepatic fibrosis. Hyperferritinaemia may be a useful biomarker for MASLD and significant fibrosis in people with T2DM.

Reproducibility of Cardiac Multifrequency MR Elastography in Assessing Left Ventricular Stiffness and Viscosity.

Cardiac magnetic resonance elastography (MRE) shows promise in assessing the mechanofunctional properties of the heart but faces clinical challenges, mainly synchronization with cardiac cycle, breathing, and external harmonic stimulation. To determine the reproducibility of in vivo cardiac multifrequency MRE (MMRE) for assessing diastolic left ventricular (LV) stiffness and viscosity. Prospective. This single-center study included a total of 28 participants (mean age, 56.6 ± 23.0 years; 16 male) consisting of randomly selected healthy participants (mean age, 44.6 ± 20.1 years; 9 male) and patients with aortic stenosis (mean age, 78.3 ± 3.8 years; 7 male). 3 T, 3D multifrequency MRE with a single-shot spin-echo planar imaging sequence. Each participant underwent two cardiac MMRE examinations on the same day. Full 3D wave fields were acquired in diastole at frequencies of 80, 90, and 100 Hz during a total of three breath-holds. Shear wave speed (SWS) and penetration rate (PR) were reconstructed as a surrogate for tissue stiffness and inverse viscous loss. Epicardial and endocardial ROIs were manually drawn by two independent readers to segment the LV myocardium. Shapiro-Wilk test, Bland-Altman analysis and intraclass correlation coefficient (ICC). P-value <0.05 were considered statistically significant. Bland-Altman analyses and intraclass correlation coefficients (ICC = 0.96 for myocardial stiffness and ICC = 0.93 for viscosity) indicated near-perfect test-retest repeatability among examinations on the same day. The mean SWS for scan and re-scan diastolic LV myocardium were 2.42 ± 0.24 m/s and 2.39 ± 0.23 m/s; the mean PR were 1.24 ± 0.17 m/s and 1.22 ± 0.14 m/s. Inter-reader variability showed good to excellent agreement for myocardial stiffness (ICC = 0.92) and viscosity (ICC = 0.85). Cardiac MMRE is a promising and reproducible method for noninvasive assessment of diastolic LV stiffness and viscosity. 2 TECHNICAL EFFICACY: 1.

MR Elastography for Classification of Focal Liver Lesions Using Viscoelastic Parameters: A Pilot Study Based on Intrinsic and Extrinsic Activations.

Intrinsic activation MR elastography (iMRE) uses cardiovascular pulsations to assess tissue viscoelastic properties. Applying it to focal liver lesions extends its capabilities. To assess the viscoelastic parameters of focal liver lesions measured by iMRE and compare its diagnostic performance with extrinsic MRE (eMRE) for differentiating malignant and benign lesions. Prospective. A total of 55 participants underwent MRI with research MRE sequences; 32 participants with 17 malignant and 15 benign lesions underwent both iMRE and eMRE. FIELD STRENGTH/SEQUENCE: iMRE at ~1 Hz heart rate used a 3 T scanner with a modified four-dimensional (4D)-quantitative flow gradient-echo phase contrast and low-velocity encoding cardiac-triggered technique. eMRE employed a gradient-echo sequence at 30, 40, and 60 Hz. Liver displacements were measured using 4D-phase contrast and reconstructed via a nonlinear inversion algorithm to determine shear stiffness (SS) and damping ratio (DR). iMRE parameters were normalized to the corresponding values from the spleen. Lesions were manually segmented, and image quality was reviewed. Kruskal-Wallis, Mann-Whitney, Dunn's test, and areas under receiver operating characteristic curves (AUC) were assessed. SS was significantly higher in malignant than benign lesions with iMRE at 1 Hz (3.69 ± 1.31 vs. 1.63 ± 0.45) and eMRE at 30 Hz (3.76 ± 1.12 vs. 2.60 ± 1.26 kPa), 40 Hz (3.76 ± 1.12 vs. 2.60 ± 1.26 kPa), and 60 Hz (7.32 ± 2.87 vs. 2.48 ± 1.12 kPa). DR was also significantly higher in malignant than benign lesions at 40 Hz (0.36 ± 0.11 vs. 0.21 ± 0.01) and 60 Hz (0.89 ± 0.86 vs. 0.22 ± 0.09). The AUC were 0.86 for iMRE SS, 0.87-0.98 for eMRE SS, 0.47 for iMRE DR, and 0.62-0.86 for eMRE DR. Cardiac-activated iMRE can characterize liver lesions and differentiate malignant from benign lesions through normalized SS maps. 2 TECHNICAL EFFICACY: Stage 2.

Longitudinal evaluation of pediatric and young adult metabolic dysfunction-associated steatotic liver disease defined by MR elastography.

To inform clinical monitoring of children and young adults with metabolic dysfunction-associated steatotic liver disease (MASLD) by characterizing the real-world natural history of MASLD and identifying baseline predictors of liver disease progression. This retrospective study included consecutive patients ages < 23 years with MASLD who underwent serial MR elastography (MRE) and/or MR fat fraction (FF) examinations between 09/2009 and 11/2022. Outcomes of MASLD were defined based on maximum ratio values. A relative change ≥ 19% in liver stiffness measures (LSM) and an absolute change ≥ 5% for liver FF were considered clinically meaningful. Random intercept models characterized the yearly rate of change in LSM (kilopascals per year) and FF (percentage per year). One hundred twenty-one patients (87 males, mean age at baseline: 12 ± 3 [SD] years) underwent 297 MRE examinations. The mean interval between the first and last MRE was 34 (± 24) months (range: 1-120 months). Among the 114 patients with serial LSM, 33% (38/114) showed progression, 46% (53/114) remained stable, and 21% (23/114) showed regression. Among the 88 patients with serial FF measures, 57% (50/88) showed progression, 2% (2/88) remained stable, and 41% (36/88) showed regression. LSM progression was associated with Hispanic ethnicity, baseline BMI-for-age percentile, baseline mean liver FF, and GGT changes over time. Predictors for liver FF progression included ALT, AST, GGT, and LDL. In a real-world sample of children and young adults with MASLD who underwent serial liver MRI, a minority of patients demonstrated improvements in liver stiffness or FF over time. Question In children, there is scarce data regarding the natural history of MASLD. Findings In this retrospective study, most children and young adults with MASLD had either unchanged or worsening liver stiffness (n = 91/114, 79%) and liver fat (n = 52/88, 59%). Clinical relevance Our findings emphasize the need for optimized care in pediatric MASLD. The identified risk factors for the progression of liver fat and stiffness may help to identify children who require interventions beyond changes in lifestyle.

Mechanical properties of pediatric low-grade gliomas in children with and without neurofibromatosis type 1.

Prognoses for pediatric brain tumors are suboptimal, as even in low-grade tumors, management techniques can lead to damage in the developing brain. Therefore, advanced neuroimaging methods are critical for developing optimal management plans and improving patient care. Magnetic resonance elastography (MRE) has allowed for the characterization of adult gliomas by their mechanical properties, which are uniquely sensitive to the complex interplay of cellularity, vasculature, and interstitium. However, pediatric tumors differ in behavior and cytoarchitecture, and their mechanical properties have never been assessed. Here, we conduct the first study of pediatric brain tumor mechanical properties by using MRE to measure tissue stiffness and damping ratio in low grade gliomas (LGGs). We additionally measure the mechanical properties of non-neoplastic focal abnormal signal intensities (FASIs) in children with neurofibromatosis type 1 (NF1). 23 patients age 4-17 years who had MR imaging results consistent with a primary LGG or with NF1 were included in this study. We found that pediatric gliomas are on an average 10.9% softer (p = 0.010) with a 17.3% lower (p = 0.009) viscosity than reference tissue. Softness of tumors appeared consistent across tumor subtypes and unrelated to tumor size or contrast-enhancement. In NF1 we found that, unlike gliomas, FASIs are stiffer, though not significantly, than reference tissue by an average of 10.4% and have a 16.7% lower damping ratio. Measuring tumor mechanical properties patterning and heterogeneity has potential to aid in prediction of biological behavior and inform management strategies for pediatric patients.

Recent developments in non-invasive methods for assessing metabolic dysfunction-associated fatty liver disease

The prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) is increasing, affecting over one-third of the global population and contributing to significant morbidity and mortality. Diagnosing MAFLD, especially with advanced fibrosis, remains challenging due to the limitations of liver biopsy, the current gold standard. Non-invasive tests are crucial for early detection and management. Among these, the fibrosis-4 index (Fib-4) is widely recommended as a first-line test for screening for liver fibrosis. Advanced imaging techniques, including ultrasound-based elastography and magnetic resonance elastography, offer high accuracy but are limited by cost and availability. Combining biomarkers, such as in the enhanced liver fibrosis score and FibroScan-AST score, enhances diagnostic precision and is recommended to further stratify patients who are considered to be intermediate or high risk from the Fib-4 score. We believe that the future lies in the combined use of biomarkers to improve diagnostic accuracy.

A 3D fast MR elastography sequence with interleaved multislab acquisition and Hadamard encoding.

To enhance the functional capability of MRI, this study aims to develop a novel MR elastography (MRE) sequence that achieves rapid acquisition without distortion artifacts. A displacement-encoded stimulated echo (DENSE) with multiphase acquisition scheme was used to capture wave images. A center-out golden-angle stack-of-stars sampling pattern was introduced for improved SNR and data incoherence. A combination of Hadamard encoding and interleaved multislab acquisition schemes was used to increase the acquisition efficiency of MRE data with multiple directions and phase offsets. A generalized parallel-imaging and compressed-sensing method was further applied to accelerate the acquisition process. The imaging results of the proposed sequence were compared with those from six gradient echo (GRE)/EPI/DENSE-based MRE sequences via phantom and brain acquisitions. The proposed sequence achieved a 6-fold acceleration compared with GRE MRE. With the application of a conventional parallel-imaging and compressed-sensing algorithm, the scanning speed was further accelerated by 8-fold, matching the speed of EPI-based MRE. Phantom tests revealed small variances in stiffness measurements across the seven sequences (< 9.23%). The proposed sequence exhibited a higher contrast-to-noise ratio (1.38) than the two EPI-based sequences (0.61/0.76) and similar to GRE-based sequences (1.34/1.22/1.58). Brain imaging validated the effectiveness of the proposed sequence in accurate stiffness estimation and distortion artifact avoidance. A rapid DENSE-based MRE sequence with interleaved multislab acquisition and Hadamard encoding was developed at a speed matching EPI-based sequences, without compromising SNR or introducing distortion artifacts.

Disparities in screening and risk stratification for hispanic adults with metabolic dysfunction-associated steatotic liver disease.

Cut-points for non-invasive tests (NITs) for risk stratification in metabolic dysfunction-associated steatotic liver disease (MASLD) were derived from predominantly non-Hispanic populations. It is unknown if these cut-points perform adequately in Hispanic individuals. We assessed the performance characteristics of current NIT cut-points among Hispanic patients and determined whether they could be further optimized. We prospectively enrolled 244 adults with biopsy-proven MASLD. Participants underwent a research visit with magnetic resonance elastography (MRE) and vibration controlled transient elastography (VCTE). Histology and imaging assessments were conducted centrally. Diagnostic performance was evaluated by area under the receiver-operating curve (AUROC) and optimal cut-points were identified by Youden J analysis. The mean (±SD) age and body mass index were 52.6 (±13) and 31.6 (±4.6) kg/m2. Overall, 40% had diabetes, 31% (N=75) were Hispanic. 40% of Hispanic and 28.4% of non-Hispanic patients had significant fibrosis. To detect significant fibrosis, MRE and VCTE exhibited significantly lower accuracy in Hispanic versus non-Hispanic participants (AUROC: MRE, 0.87 vs. 0.98, p=0.01; VCTE, 0.78 vs. 0.92, p=0.02). Clinical care algorithms yielded high false-negative rates among Hispanic participants (14% with low-risk FIB-4 and 21% with low-risk VCTE had advanced fibrosis on biopsy). Cut-points of 2.73kPa for MRE and 6.9kPa for VCTE were optimal to detect significant fibrosis in Hispanic individuals. Findings were validated in a Latin American cohort. Lower NIT cut-points may be needed to optimize surveillance for significant fibrosis due to MASLD in Hispanic populations commensurate with their higher burden and severity of disease.

High-frequency shear wave MR elastography of parotid glands: custom driver design and preliminary results.

Parotid glands are one of the most common sites for salivary gland tumors. Conventional imaging techniques have limited usefulness in the quantitative assessment of the parotid glands, making it difficult to differentiate between healthy tissue and tumors, as well as between benign and malignant tumors. Magnetic resonance elastography (MRE) is a non-invasive technique that may potentially overcome these limitations. Nevertheless, due to the size of the parotid gland, increased elastographic resolution is required. This may be achieved by applying shear waves at higher frequencies. However, it also results in stronger attenuation, making the illumination of the parotid challenging. Here, we describe a novel passive driver tailored to the anatomy of the human face, which minimizes the distance shear waves need to travel from the source to the area of interest and thus decreases shear wave attenuation, making high-frequency shear wave MRE feasible.

Magnetic Resonance Elastography for the Detection and Classification of Prostate Cancer.

We investigated the feasibility of magnetic resonance elastography (MRE) using a pelvic acoustic driver for the detection and classification of prostate cancer (PCa). A total of 75 consecutive patients (mean age, 70; range, 56-86) suspected of having PCa and who underwent multi-parametric MRI including MRE and subsequent surgical resection were included. The analyzed regions consisted of cancer (n = 69), benign prostatic hyperplasia (BPH) (n = 70), and normal parenchyma (n = 70). A histopathologic topographic map served as the reference standard for each region. One radiologist and one pathologist performed radiologic-pathologic correlation, and the radiologist measured stiffness values in each region of interest on elastograms automatically generated by dedicated software. Paired t-tests were used to compare stiffness values between two regions. ROC curve analysis was also used to extract a cutoff value between two regions. The stiffness value of PCa (unit, kilopascal (kPa); 4.9 ± 1.1) was significantly different to that of normal parenchyma (3.6 ± 0.3, p < 0.0001) and BPH (4.5 ± 1.4, p = 0.0454). Under a cutoff value of 4.2 kPa, a maximum accuracy of 87% was estimated, with a sensitivity of 73%, a specificity of 99%, and an AUC of 0.839 for discriminating PCa from normal parenchyma. Between PCa and BPH, a maximum accuracy of 62%, a sensitivity of 70%, a specificity of 56%, and an AUC of 0.598 were estimated at a 4.5 kPa cutoff. The stiffness values tended to increase as the ISUP grade increased. In conclusion, it is feasible to detect and classify PCa using pelvic MRE. Our observations suggest that MRE could be a supplement to multi-parametric MRI for PCa detection.

Advanced imaging techniques and non-invasive biomarkers in pediatric brain tumors: state of the art.

In the pediatric age group, brain neoplasms are the second most common tumor category after leukemia, with an annual incidence of 6.13 per 100,000. Conventional MRI sequences, complemented by CT whenever necessary, are fundamental for the initial diagnosis and surgical planning as well as for post-operative evaluations, assessment of response to treatment, and surveillance; however, they have limitations, especially concerning histopathologic or biomolecular phenotyping and grading. In recent years, several advanced MRI sequences, including diffusion-weighted imaging, diffusion tensor imaging, arterial spin labelling (ASL) perfusion, and MR spectroscopy, have emerged as a powerful aid to diagnosis as well as prognostication; furthermore, other techniques such as diffusion kurtosis, amide proton transfer imaging, and MR elastography are being translated from the research environment to clinical practice. Molecular imaging, especially PET with amino-acid tracers, complement MRI in several aspects, including biopsy targeting and outcome prediction. Finally, radiomics with radiogenomics are opening entirely new perspectives for a quantitative approach aiming at identifying biomarkers that can be used for personalized, precision management strategies.

Characterizing brain mechanics through 7 tesla magnetic resonance elastography

Magnetic resonance elastography (MRE) is a non-invasive method for determining the mechanical response of tissues using applied harmonic deformation and motion-sensitive MRI. MRE studies of the human brain are typically performed at conventional field strengths, with a few attempts at the ultra-high field strength, 7T, reporting increased spatial resolution with partial brain coverage. Achieving high-resolution human brain scans using 7T MRE presents unique challenges of decreased octahedral shear strain-based signal-to-noise ratio (OSS-SNR) and lower shear wave motion sensitivity. In this study, we establish high resolution MRE at 7T with a custom 2D multi-slice single-shot spin-echo echo-planar imaging sequence, using the Gadgetron advanced image reconstruction framework, applying Marchenko-Pastur Principal component analysis denoising, and using nonlinear viscoelastic inversion. These techniques allowed us to calculate the viscoelastic properties of the whole human brain at 1.1 mm isotropic imaging resolution with high OSS-SNR and repeatability. Using phantom models and 7T MRE data of eighteen healthy volunteers, we demonstrate the robustness and accuracy of our method at high-resolution while quantifying the feasible tradeoff between resolution, OSS-SNR, and scan time. Using these post-processing techniques, we significantly increased OSS-SNR at 1.1 mm resolution with whole-brain coverage by approximately 4-fold and generated elastograms with high anatomical detail. Performing high-resolution MRE at 7T on the human brain can provide information on different substructures within brain tissue based on their mechanical properties, which can then be used to diagnose pathologies (e.g. Alzheimer's disease), indicate disease progression, or better investigate neurodegeneration effects or other relevant brain disorders,in vivo.

B-063 Changes in nonalcoholic fatty liver disease and M2BPGi due to lifestyle intervention in primary healthcare

Abstract Background A healthy lifestyle is the most important method for managing nonalcoholic fatty liver disease (NAFLD). Mac-2-binding protein glycosylated isomer (M2BPGi) has been suggested as a biomarker for NAFLD. This study aimed to determine the efficacy of personalized lifestyle interventions on NAFLD remission. Methods This single-arm intervention study recruited participants with NAFLD who underwent health checkups at seven health-promotion centers in five South Korean cities. Fatty liver diagnosis was based on ultrasonography (US). The 109 individuals were recruited for personalized lifestyle interventions of hypocaloric diets and exercise. The participants attended the lifestyle intervention programs once per month for the first 3 months, and once every 3 months for the subsequent 6 months. And phone-based self-monitoring were also provided monthly during the 3-month follow-up period. The primary outcome was NAFLD remission at month 12 as measured on US and magnetic resonance elastography. The secondary outcomes were the changes in metabolic factors and M2BPGi. Results The 108 individuals (62 males and 46 females; age 51.1±12.4 years, mean±standard deviation) were finally analyzed after the 12month intervention. Body mass index, waist circumference (WC), blood pressure, blood lipids (total cholesterol, triglycerides, and HDL-C), and fasting blood sugar levels were improved relative to baseline (all P&amp;lt;0.05). Fatty liver at or above the moderate grade according to US was decreased at month 12 relative to baseline (67.6% vs 50.9%) (P=0.002). M2BPGi levels decreased during the 12-month study period (P&amp;lt;0.001). M2BPGi levels were moderately correlated with hepatic fat fraction by magnetic resonance imaging (r=0.33, P=0.05). WC (OR=0.82, 95% CI=0.67-1.00, P=0.05) and HDL-C (OR=1.17, 95% CI=1.03-1.32, P=0.014) were associated with remission of fatty liver in the multivariate analysis. Conclusions The personalized lifestyle intervention was effective in improving fatty liver and metabolic factors, but not hepatic stiffness, in NAFLD.

Force and Energy Transmission at the Brain-Skull Interface of the Minipig In Vivo and Post-Mortem

The brain-skull interface plays an important role in the mechano-pathology of traumatic brain injury (TBI). A comprehensive understanding of the mechanical behavior of the brain-skull interface in vivo is significant for understanding the mechanisms of TBI and creating accurate computational models. Here we investigate the force and energy transmission at the minipig brain-skull interface by non-invasive methods in the live (in vivo) and dead animal (in situ). Displacement fields in the brain and skull were measured in four female minipigs by magnetic resonance elastography (MRE), and the relative displacements between the brain and skull were estimated. Surface maps of deviatoric stress, the apparent mechanical properties of the brain-skull interface, and the net energy flux were generated for each animal when alive and at specific times post-mortem. After death, these maps reveal increases in relative motion between brain and skull, brain surface stress, stiffness of brain-skull interface, and net energy flux from skull to brain. These results illustrate the ability to study both skull and brain mechanics by MRE; the observed post-mortem decrease in the protective capability of the brain-skull interface emphasizes the importance of measuring its behavior in vivo.

Pregnancy alters fatty acid metabolism, glucose regulation, and detoxification of the liver in synchrony with biomechanical property changes

Pregnancy places a metabolic burden on the body including the liver, which is responsible for ensuring adequate nutrition for the maternal and fetal systems. To gain a better understanding of liver adaptation, this study investigates metabolic shifts occurring in livers of pregnant rats. Metabolic capacities of the livers of pregnant and non-pregnant female Wistar rats were assessed using comprehensive metabolic models. Kinetic metabolic models were generated for each animal based on protein abundance data from proteomics analysis allowing for a subject-specific assessment of hepatic metabolic functions. Data are available via ProteomeXchange with identifier PXD050758. Additionally, tissue stiffness, viscosity, and water diffusion obtained from magnetic resonance imaging and elastography were correlated with metabolic capabilities to study the relationship between metabolic function and biophysical properties. Proteome profiling revealed differences in protein expression in the livers of pregnant and non-pregnant animals. Functional analysis showed significant variations in metabolic capacities. Livers of pregnant rats had reduced capacities in carbohydrate and fatty acid metabolism, along with altered urea synthesis. Additionally, there were associations between metabolic functions and biophysical properties highlighting potential links between changes in liver structure and metabolic capacities during pregnancy. In summary, our work reveals extensive hepatic metabolic changes in pregnant rats. The liver adapts its metabolic capacities to ensure whole-body metabolic homeostasis but may struggle to counteract nutritional challenges, such as hypoglycemia. The study, employing a personalized approach combining proteomics, kinetic modeling, and advanced imaging, sheds light on the intricate interplay between hepatic adaptations and medical imaging markers, providing a foundation for further investigations into the implications for maternal and fetal health.

MR elastography vs a combination of common non-invasive tests for estimation of severe liver fibrosis in patients with hepatobiliary tumors.

To evaluate the accuracy of combined imaging and blood test indices related to liver fibrosis (LF) compared to magnetic resonance elastography (MRE) for estimating severe LF (F3-4) in preoperative patients. This retrospective study included patients who underwent MRE, gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI, and dynamic CT before liver resection. Liver stiffness measurement (LSM) using MRE, liver-to-spleen signal intensity ratio (LSR) using Gd-EOB-DTPA-enhanced MRI, and spleen volume normalized to body surface area (SV/BSA) using CT volumetry were measured. Laboratory parameters, including levels of type IV collagen 7S and hyaluronic acid, were also measured. Logistic regression and receiver operating characteristic analyses were performed to identify parameters that could estimate severe LF more accurately than LSM alone. A total of 81 patients (mean age, 67 years ± 9.9 [SD]; 58 men) were enrolled. Multivariable logistic regression analysis indicated that LSR (odds ratio [OR]: 0.14, 95% confidence interval [CI]: 0.05-0.37, p < 0.001), SV/BSA (OR: 1.25, 95% CI: 1.02-1.52, p = 0.03) and type IV collagen 7S (OR: 1.84, 95% CI: 1.12-3.00, p = 0.02) were associated with severe LF. Receiver operating characteristic analysis showed that for estimating severe LF, the area under the curve was significantly larger for the combination of LSR, SV/BSA, and type IV collagen 7S than for LSM alone (0.95 vs 0.85, p = 0.04). The combined evaluation of LSR, SV/BSA, and type IV collagen 7S obtained by clinically common preoperative examinations was more accurate than MRE alone for estimating severe LF in preoperative patients. Question What indicators among the imaging and blood tests commonly performed preoperatively can provide a more accurate estimate of severe LF compared to MRE? Findings The combination of LSR, SV/BSA, and type IV collagen 7S was more accurate thanan LSM alone for estimating severe LF. Clinical relevance A combination of commonly performed non-invasive preoperative tests provides a more accurate estimation of severe LF than MR elastography, an examination with relatively limited.

Comparative efficacy of THR-β agonists, FGF-21 analogues, GLP-1R agonists, GLP-1-based polyagonists, and Pan-PPAR agonists for MASLD: A systematic review and network meta-analysis

AimsTo compare the efficacy of thyroid hormone receptor beta (THR-β) agonists, fibroblast growth factor 21 (FGF-21) analogues, glucagon-like peptide-1 receptor agonists (GLP-1RAs), GLP-1-based polyagonists, and pan-peroxisome proliferator-activated receptor (Pan-PPAR) agonists in the treatment of metabolic dysfunction-associated steatotic liver disease (MASLD). MethodsA database search for relevant randomized double-blind controlled trials published until July 11, 2024, was conducted. Primary outcomes were the relative change in hepatic fat fraction (HFF) and liver stiffness assessed non-invasively by magnetic resonance imaging proton density fat fraction and elastography. Secondary outcomes included histology, liver injury index, lipid profile, glucose metabolism, blood pressure, and body weight. ResultsTwenty-seven trials (5357 patients with MASLD) were identified. For HFF reduction, GLP-1-based polyagonists were most potentially effective (mean difference [MD] −51.47; 95 % confidence interval [CI]: −68.25 to −34.68; surface under the cumulative ranking curve [SUCRA] 84.9) vs. placebo, followed by FGF-21 analogues (MD −47.08; 95 % CI: −58.83 to −35.34; SUCRA 75.5), GLP-1R agonists (MD −37.36; 95 % CI: −69.52 to −5.21; SUCRA 52.3) and THR-β agonists (MD −33.20; 95 % CI: −43.90 to −22.51; SUCRA 36.9). For liver stiffness, FGF-21 analogues were most potentially effective (MD −9.65; 95 % CI: −19.28 to −0.01; SUCRA 82.2) vs. placebo, followed by THR-β agonists (MD −5.79; 95 % CI: −9.50 to −2.09; SUCRA 58.2), and GLP-1RAs (MD −5.58; 95 % CI: −15.02 to 3.86; SUCRA 54.7). For fibrosis improvement in histology, GLP-1-based polyagonists were most potentially effective, followed by FGF-21 analogues, THR-β agonists, Pan-PPAR agonists, and GLP-1R agonists; For MASH resolution in histology, GLP-1-based polyagonists were most potentially effective, followed by THR-β agonists, GLP-1R agonists, FGF-21 analogues, and Pan-PPAR agonists. THR-β agonists are well-balanced in liver steatosis and fibrosis, and excel at improving lipid profiles; FGF-21 analogues are effective at improving steatosis and particularly exhibit strong antifibrotic abilities. GLP-1R agonists showed significant benefits in improving liver steatosis, glucose metabolism, and body weight. GLP-1-based polyagonists have demonstrated the most potential efficacy overall in terms of comprehensive curative effect. Pan-PPAR agonists showed distinct advantages in improving liver function and glucose metabolism. ConclusionThese results illustrate the relative superiority of the five classes of therapy in the treatment of MASLD and may serve as guidance for the development of combination therapies.

Role of Ultrasound and Magnetic Resonance Elastography in Evaluation of Hepatic Fibrosis in Patients with Viral Hepatitis B And C : A Clinical Review

Role of Ultrasound and Magnetic Resonance Elastography in Evaluation of Hepatic Fibrosis in Patients with Viral Hepatitis B And C : A Clinical Review

Obesity increases the risk of hepatic fibrosis in young adults with type 2 diabetes mellitus: the need to screen.

The objective of this study was to determine the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) in young compared with older adults. Individuals (n = 1420) with (63%) and without type 2 diabetes mellitus (T2D; 37%) who attended internal medicine clinics and did not have a known history of MASLD underwent laboratory evaluation and transient elastography to assess for hepatic steatosis and fibrosis. Magnetic resonance elastography and liver biopsy were recommended when indicated. A total of 243 participants were ages <45 years, and 1177 were ages ≥45 years. Obesity, T2D, and metabolic syndrome were highly prevalent in young adults. Frequencies of steatosis and fibrosis were high in young adults (50.2% and 7.5% vs. older adults 52.7% and 9.9%, respectively) and were significantly higher in those with both obesity and T2D (71.1% and 15.7%, respectively; p < 0.01). In young adults, T2D and obesity were the strongest risk factors for hepatic fibrosis (odds ratios 4.33 [95% CI: 1.37-13.68] and 1.16 [95% CI: 1.07-1.25], respectively; p < 0.05). There is a high prevalence of clinically significant hepatic fibrosis in young adults with cardiometabolic risk factors. Up to one in seven young adults with obesity and T2D had clinically significant hepatic fibrosis on elastography. This highlights the need to screen young adults with cardiometabolic risk factors for MASLD for early detection and intervention.

Sensor-Embedded Tissue Phantom for Magnetic Resonance Elastography Mechanical Failure Testing

Abstract Magnetic Resonance Elastography (MRE) is an imaging technique capable of quantifying the stiffness of in vivo tissue by applying and imaging shear waves produced by an MRE actuator. Poor image acquisition may result from the MRE procedure if there is insufficient contact between the MRE actuator and the patient. An experimental test setup outside of the clinic will aid in reducing the number of failed acquisitions by enabling the development of advanced actuators and actuator systems. This work presents the development and testing of a sensor-embedded tissue phantom setup paired with a support vector machine (SVM) classifier to automate the MRE actuator testing process. MRE actuation of soft tissue is simulated by utilizing a voice coil positioning stage that interfaces with a phantom. To capture the resulting vibrations, accelerometers are embedded inside the phantom. Subsequent characterization experiments verify the functionality of the developed phantoms to capture wave propagation. A secondary investigation was performed by utilizing the developed setup to collect acceleration measurements at varying contact distances. We provide an overview of feature analysis and selection to develop SVM models for contact detection. Multiple SVM models are reported, and the best-performing model displayed almost perfect validation (94.53%) and test (90.91%) accuracy. The pairing of sensor-embedded phantom with an SVM for detection demonstrates potential improvements to the MRE actuator developmental process by automatically assessing contact-related issues prior to clinical testing.