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  1. Article ; Online: Fat Quantification in the Abdomen.

    Hong, Cheng William / Fazeli Dehkordy, Soudabeh / Hooker, Jonathan C / Hamilton, Gavin / Sirlin, Claude B

    Topics in magnetic resonance imaging : TMRI

    2017  Volume 26, Issue 6, Page(s) 221–227

    Abstract: Fatty liver disease is characterized histologically by hepatic steatosis, the abnormal accumulation of lipid in hepatocytes. It is classified into alcoholic fatty liver disease and nonalcoholic fatty liver disease, and is an increasingly important cause ... ...

    Abstract Fatty liver disease is characterized histologically by hepatic steatosis, the abnormal accumulation of lipid in hepatocytes. It is classified into alcoholic fatty liver disease and nonalcoholic fatty liver disease, and is an increasingly important cause of chronic liver disease and cirrhosis. Assessing the severity of hepatic steatosis in these conditions is important for diagnostic and prognostic purposes, as hepatic steatosis is potentially reversible if diagnosed early. The criterion standard for assessing hepatic steatosis is liver biopsy, which is limited by sampling error, its invasive nature, and associated morbidity. As such, noninvasive imaging-based methods of assessing hepatic steatosis are needed. Ultrasound and computed tomography are able to suggest the presence of hepatic steatosis based on imaging features, but are unable to accurately quantify hepatic fat content. Since Dixon's seminal work in 1984, magnetic resonance imaging has been used to compute the signal fat fraction from chemical shift-encoded imaging, commonly implemented as out-of-phase and in-phase imaging. However, signal fat fraction is confounded by several factors that limit its accuracy and reproducibility. Recently, advanced chemical shift-encoded magnetic resonance imaging methods have been developed that address these confounders and are able to measure the proton density fat fraction, a standardized, accurate, and reproducible biomarker of fat content. The use of these methods in the liver, as well as in other abdominal organs such as the pancreas, adrenal glands, and adipose tissue will be discussed in this review.
    MeSH term(s) Abdomen/diagnostic imaging ; Abdomen/pathology ; Fatty Liver/diagnostic imaging ; Fatty Liver/metabolism ; Fatty Liver/pathology ; Humans ; Intra-Abdominal Fat/diagnostic imaging ; Magnetic Resonance Imaging/methods ; Reproducibility of Results ; Tomography, X-Ray Computed/methods
    Language English
    Publishing date 2017-11-25
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1112716-8
    ISSN 1536-1004 ; 0899-3459
    ISSN (online) 1536-1004
    ISSN 0899-3459
    DOI 10.1097/RMR.0000000000000141
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  2. Article ; Online: MR elastography in nonalcoholic fatty liver disease: inter-center and inter-analysis-method measurement reproducibility and accuracy at 3T.

    Tang, An / Dzyubak, Bogdan / Yin, Meng / Schlein, Alexandra / Henderson, Walter C / Hooker, Jonathan C / Delgado, Timoteo I / Middleton, Michael S / Zheng, Lin / Wolfson, Tanya / Gamst, Anthony / Loomba, Rohit / Ehman, Richard L / Sirlin, Claude B

    European radiology

    2021  Volume 32, Issue 5, Page(s) 2937–2948

    Abstract: Objectives: To assess reproducibility and fibrosis classification accuracy of magnetic resonance elastography (MRE)-determined liver stiffness measured manually at two different centers, and by automated analysis software in adults with nonalcoholic ... ...

    Abstract Objectives: To assess reproducibility and fibrosis classification accuracy of magnetic resonance elastography (MRE)-determined liver stiffness measured manually at two different centers, and by automated analysis software in adults with nonalcoholic fatty liver disease (NAFLD), using histopathology as a reference standard.
    Methods: This retrospective, cross-sectional study included 91 adults with NAFLD who underwent liver MRE and biopsy. MRE-determined liver stiffness was measured independently for this analysis by an image analyst at each of two centers using standardized manual analysis methodology, and separately by an automated analysis. Reproducibility was assessed pairwise by intraclass correlation coefficient (ICC) and Bland-Altman analysis. Diagnostic accuracy was assessed by receiver operating characteristic (ROC) analyses.
    Results: ICC of liver stiffness measurements was 0.95 (95% CI: 0.93, 0.97) between center 1 and center 2 analysts, 0.96 (95% CI: 0.94, 0.97) between the center 1 analyst and automated analysis, and 0.94 (95% CI: 0.91, 0.96) between the center 2 analyst and automated analysis. Mean bias and 95% limits of agreement were 0.06 ± 0.38 kPa between center 1 and center 2 analysts, 0.05 ± 0.32 kPa between the center 1 analyst and automated analysis, and 0.11 ± 0.41 kPa between the center 2 analyst and automated analysis. The area under the ROC curves for the center 1 analyst, center 2 analyst, and automated analysis were 0.834, 0.833, and 0.847 for distinguishing fibrosis stage 0 vs. ≥ 1, and 0.939, 0.947, and 0.940 for distinguishing fibrosis stage ≤ 2 vs. ≥ 3.
    Conclusion: MRE-determined liver stiffness can be measured with high reproducibility and fibrosis classification accuracy at different centers and by an automated analysis.
    Key points: • Reproducibility of MRE liver stiffness measurements in adults with nonalcoholic fatty liver disease is high between two experienced centers and between manual and automated analysis methods. • Analysts at two centers had similar high diagnostic accuracy for distinguishing dichotomized fibrosis stages. • Automated analysis provides similar diagnostic accuracy as manual analysis for advanced fibrosis.
    MeSH term(s) Adult ; Cross-Sectional Studies ; Elasticity Imaging Techniques/methods ; Fibrosis ; Humans ; Liver/diagnostic imaging ; Liver/pathology ; Liver Cirrhosis/diagnostic imaging ; Liver Cirrhosis/pathology ; Magnetic Resonance Imaging/methods ; Non-alcoholic Fatty Liver Disease/diagnostic imaging ; Non-alcoholic Fatty Liver Disease/pathology ; ROC Curve ; Reproducibility of Results ; Retrospective Studies
    Language English
    Publishing date 2021-12-20
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1085366-2
    ISSN 1432-1084 ; 0938-7994 ; 1613-3749
    ISSN (online) 1432-1084
    ISSN 0938-7994 ; 1613-3749
    DOI 10.1007/s00330-021-08381-z
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  3. Article ; Online: Longitudinal evolution of CT and MRI LI-RADS v2014 category 1, 2, 3, and 4 observations.

    Hong, Cheng William / Park, Charlie C / Mamidipalli, Adrija / Hooker, Jonathan C / Fazeli Dehkordy, Soudabeh / Igarashi, Saya / Alhumayed, Mohanad / Kono, Yuko / Loomba, Rohit / Wolfson, Tanya / Gamst, Anthony / Murphy, Paul / Sirlin, Claude B

    European radiology

    2019  Volume 29, Issue 9, Page(s) 5073–5081

    Abstract: Objectives: This study assesses the risk of progression of Liver Imaging Reporting and Data System (LI-RADS) categories, and the effects of inter-exam changes in modality or radiologist on LI-RADS categorization.: Methods: Clinical LI-RADS v2014 CT ... ...

    Abstract Objectives: This study assesses the risk of progression of Liver Imaging Reporting and Data System (LI-RADS) categories, and the effects of inter-exam changes in modality or radiologist on LI-RADS categorization.
    Methods: Clinical LI-RADS v2014 CT and MRI exams at our institution between January 2014 and September 2017 were retrospectively identified. Untreated LR-1, LR-2, LR-3, and LR-4 observations with at least one follow-up exam were included. Three hundred and seventy-two observations in 214 patients (149 male, 65 female, mean age 61 ± 10 years) were included during the study period (715 exams total). Cumulative incidence curves for progression to malignant LI-RADS categories (LR-5 or LR-M) and to LR-4 or higher were generated for each index category and compared using log-rank tests with a resampling extension. Relationships between inter-exam changes in LI-RADS category and modality or radiologist, adjusted for inter-exam time intervals, were modeled using mixed effect logistic regressions.
    Results: Median inter-exam follow-up interval and total follow-up duration were 123 and 227 days, respectively. Index LR-1, LR-2, LR-3, and LR-4 differed significantly in their cumulative incidences of progression to malignant categories (p < 0.0001), which were 0%, 2%, 7%, and 32% at 6 months, respectively. Index LR-1, LR-2, and LR-3 differed significantly in cumulative incidences of progression to LR-4 or higher (p = 0.003). MRI-MRI exam pairs had more stable LI-RADS categorization compared to CT-CT (OR = 0.460, p = 0.0018).
    Conclusions: LI-RADS observations demonstrate increasing risk of progression to malignancy with increasing category ranging from 0% for LR-1 to 32% for LR-4 at 6 months. Inter-exam modality changes are associated with LI-RADS category changes.
    Key points: • While the majority of LR-2 observations remain stable over long-term follow-up, LR-3 and especially LR-4 observations have a higher risk for category progression. • Category transitions between sequential exams using different modalities (CT vs. MRI) may reflect modality differences rather than biological change. MRI, especially with the same type of contrast agent, may provide the most reproducible categorization, although this needs additional validation. • In a clinical practice setting, in which radiologists refer to prior imaging and reports, there was no significant association between changes in radiologist and changes in LI-RADS categorization.
    MeSH term(s) Carcinoma, Hepatocellular/diagnosis ; Disease Progression ; Female ; Humans ; Liver/diagnostic imaging ; Liver Neoplasms/diagnosis ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Multidetector Computed Tomography/methods ; ROC Curve ; Retrospective Studies
    Language English
    Publishing date 2019-02-26
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1085366-2
    ISSN 1432-1084 ; 0938-7994 ; 1613-3749
    ISSN (online) 1432-1084
    ISSN 0938-7994 ; 1613-3749
    DOI 10.1007/s00330-019-06058-2
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  4. Article ; Online: Measurement of spleen fat on MRI-proton density fat fraction arises from reconstruction of noise.

    Hong, Cheng William / Hamilton, Gavin / Hooker, Catherine / Park, Charlie C / Tran, Calvin Andrew / Henderson, Walter C / Hooker, Jonathan C / Fazeli Dehkordy, Soudabeh / Schwimmer, Jeffrey B / Reeder, Scott B / Sirlin, Claude B

    Abdominal radiology (New York)

    2019  Volume 44, Issue 10, Page(s) 3295–3303

    Abstract: Purpose: This study compares splenic proton density fat fraction (PDFF) measured using confounder-corrected chemical shift-encoded (CSE)-MRI to magnetic resonance spectroscopy (MRS) in human patients at 3T.: Methods: This was a prospectively designed ...

    Abstract Purpose: This study compares splenic proton density fat fraction (PDFF) measured using confounder-corrected chemical shift-encoded (CSE)-MRI to magnetic resonance spectroscopy (MRS) in human patients at 3T.
    Methods: This was a prospectively designed ancillary study to various previously described single-center studies performed in adults and children with known or suspected nonalcoholic fatty liver disease. Patients underwent magnitude-based MRI (MRI-M), complex-based MRI (MRI-C), high signal-to-noise variants (Hi-SNR MRI-M and Hi-SNR MRI-C), and MRS at 3T for spleen PDFF estimation. PDFF from CSE-MRI methods were compared to MRS-PDFF using Wilcoxon signed-rank tests. Demographics were summarized descriptively. Spearman's rank correlations were computed pairwise between CSE-MRI methods. Individual patient measurements were plotted for qualitative assessment. A significance level of 0.05 was used.
    Results: Forty-seven patients (20 female, 27 male) including 12 adults (median 55 years old) and 35 children (median 12 years old). Median PDFF estimated by MRS, MRI-M, Hi-SNR MRI-M, MRI-C, and Hi-SNR MRI-C was 1.0, 2.3, 1.9, 2.2, and 2.0%. The four CSE-MRI methods estimated statistically significant higher spleen PDFF values compared to MRS (p < 0.0001 for all). Pairwise associations in spleen PDFF values measured by different CSE-MRI methods were weak, with the highest Spearman's rank correlations being 0.295 between MRI-M and Hi-SNR MRI-M; none were significant after correction for multiple comparisons. No qualitative relationship was observed between PDFF measurements among the various methods.
    Conclusion: Overestimation of PDFF by CSE-MRI compared to MRS and poor agreement between related CSE-MRI methods suggest that non-zero PDFF values in human spleen are artifactual.
    MeSH term(s) Adipose Tissue/diagnostic imaging ; Adolescent ; Adult ; Algorithms ; Child ; Female ; Humans ; Image Interpretation, Computer-Assisted ; Imaging, Three-Dimensional ; Magnetic Resonance Imaging/methods ; Magnetic Resonance Spectroscopy/methods ; Male ; Middle Aged ; Prospective Studies ; Signal-To-Noise Ratio ; Spleen/diagnostic imaging
    Language English
    Publishing date 2019-06-06
    Publishing country United States
    Document type Case Reports ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 2839786-1
    ISSN 2366-0058 ; 2366-004X
    ISSN (online) 2366-0058
    ISSN 2366-004X
    DOI 10.1007/s00261-019-02079-z
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  5. Article ; Online: Magnetic resonance elastography biomarkers for detection of histologic alterations in nonalcoholic fatty liver disease in the absence of fibrosis.

    Qu, Yali / Middleton, Michael S / Loomba, Rohit / Glaser, Kevin J / Chen, Jun / Hooker, Jonathan C / Wolfson, Tanya / Covarrubias, Yesenia / Valasek, Mark A / Fowler, Kathryn J / Zhang, Yingzhen N / Sy, Ethan / Gamst, Anthony C / Wang, Kang / Mamidipalli, Adrija / Schwimmer, Jeffrey B / Song, Bin / Reeder, Scott B / Yin, Meng /
    Ehman, Richard L / Sirlin, Claude B

    European radiology

    2021  Volume 31, Issue 11, Page(s) 8408–8419

    Abstract: Objectives: To investigate associations between histology and hepatic mechanical properties measured using multiparametric magnetic resonance elastography (MRE) in adults with known or suspected nonalcoholic fatty liver disease (NAFLD) without ... ...

    Abstract Objectives: To investigate associations between histology and hepatic mechanical properties measured using multiparametric magnetic resonance elastography (MRE) in adults with known or suspected nonalcoholic fatty liver disease (NAFLD) without histologic fibrosis.
    Methods: This was a retrospective analysis of 88 adults who underwent 3T MR exams including hepatic MRE and MR imaging to estimate proton density fat fraction (MRI-PDFF) within 180 days of liver biopsy. Associations between MRE mechanical properties (mean shear stiffness (|G*|) by 2D and 3D MRE, and storage modulus (G'), loss modulus (G″), wave attenuation (α), and damping ratio (ζ) by 3D MRE) and histologic, demographic and anthropometric data were assessed.
    Results: In univariate analyses, patients with lobular inflammation grade ≥ 2 had higher 2D |G*| and 3D G″ than those with grade ≤ 1 (p = 0.04). |G*| (both 2D and 3D), G', and G″ increased with age (rho = 0.25 to 0.31; p ≤ 0.03). In multivariable regression analyses, the association between inflammation grade ≥ 2 remained significant for 2D |G*| (p = 0.01) but not for 3D G″ (p = 0.06); age, sex, or BMI did not affect the MRE-inflammation relationship (p > 0.20).
    Conclusions: 2D |G*| and 3D G″ were weakly associated with moderate or severe lobular inflammation in patients with known or suspected NAFLD without fibrosis. With further validation and refinement, these properties might become useful biomarkers of inflammation. Age adjustment may help MRE interpretation, at least in patients with early-stage disease.
    Key points: • Moderate to severe lobular inflammation was associated with hepatic elevated shear stiffness and elevated loss modulus (p =0.04) in patients with known or suspected NAFLD without liver fibrosis; this suggests that with further technical refinement these MRE-assessed mechanical properties may permit detection of inflammation before the onset of fibrosis in NAFLD. • Increasing age is associated with higher hepatic shear stiffness, and storage and loss moduli (rho = 0.25 to 0.31; p ≤ 0.03); this suggests that age adjustment may help interpret MRE results, at least in patients with early-stage NAFLD.
    MeSH term(s) Biomarkers ; Elasticity Imaging Techniques ; Fibrosis ; Humans ; Liver/diagnostic imaging ; Liver/pathology ; Liver Cirrhosis/diagnostic imaging ; Liver Cirrhosis/pathology ; Magnetic Resonance Imaging ; Non-alcoholic Fatty Liver Disease/diagnostic imaging ; Non-alcoholic Fatty Liver Disease/pathology ; Prospective Studies ; Retrospective Studies
    Chemical Substances Biomarkers
    Language English
    Publishing date 2021-04-26
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1085366-2
    ISSN 1432-1084 ; 0938-7994 ; 1613-3749
    ISSN (online) 1432-1084
    ISSN 0938-7994 ; 1613-3749
    DOI 10.1007/s00330-021-07988-6
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  6. Article ; Online: LI-RADS Version 2018 Ancillary Features at MRI.

    Cerny, Milena / Chernyak, Victoria / Olivié, Damien / Billiard, Jean-Sébastien / Murphy-Lavallée, Jessica / Kielar, Ania Z / Elsayes, Khaled M / Bourque, Laurence / Hooker, Jonathan C / Sirlin, Claude B / Tang, An

    Radiographics : a review publication of the Radiological Society of North America, Inc

    2018  Volume 38, Issue 7, Page(s) 1973–2001

    Abstract: The Liver Imaging Reporting and Data System (LI-RADS) standardizes performance of liver imaging in patients at risk for hepatocellular carcinoma (HCC) as well as interpretation and reporting of the results. Developed by experts in liver imaging and ... ...

    Abstract The Liver Imaging Reporting and Data System (LI-RADS) standardizes performance of liver imaging in patients at risk for hepatocellular carcinoma (HCC) as well as interpretation and reporting of the results. Developed by experts in liver imaging and supported by the American College of Radiology, LI-RADS assigns to observations categories that reflect the relative probability of benignity, HCC, or other malignancy. While category assignment is based mainly on major imaging features, ancillary features may be applied to improve detection and characterization, increase confidence, or adjust LI-RADS categories. Ancillary features are classified as favoring malignancy in general, HCC in particular, or benignity. Those favoring malignancy in general or HCC in particular may be used to upgrade by a maximum of one category up to LR-4; those favoring benignity may be used to downgrade by a maximum of one category. If there are conflicting ancillary features (ie, one or more favoring malignancy and one or more favoring benignity), the category should not be adjusted. Ancillary features may be seen at diagnostic CT, MRI performed with extracellular agents, or MRI performed with hepatobiliary agents, with the exception of one ancillary feature assessed at US. This article focuses on LI-RADS version 2018 ancillary features seen at MRI. Specific topics include rules for ancillary feature application; definitions, rationale, and illustrations with clinical MRI examples; summary of evidence and diagnostic performance; pitfalls; and future directions.
    MeSH term(s) Algorithms ; Carcinoma, Hepatocellular/diagnostic imaging ; Contrast Media ; Humans ; Liver Neoplasms/diagnostic imaging ; Magnetic Resonance Imaging/methods ; Precancerous Conditions/diagnostic imaging
    Chemical Substances Contrast Media
    Language English
    Publishing date 2018-10-05
    Publishing country United States
    Document type Journal Article ; Review ; Video-Audio Media
    ZDB-ID 603172-9
    ISSN 1527-1323 ; 0271-5333
    ISSN (online) 1527-1323
    ISSN 0271-5333
    DOI 10.1148/rg.2018180052
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  7. Article ; Online: Inter-reader agreement of magnetic resonance imaging proton density fat fraction and its longitudinal change in a clinical trial of adults with nonalcoholic steatohepatitis.

    Hooker, Jonathan C / Hamilton, Gavin / Park, Charlie C / Liao, Steven / Wolfson, Tanya / Dehkordy, Soudabeh Fazeli / Hong, Cheng William / Mamidipalli, Adrija / Gamst, Anthony / Loomba, Rohit / Sirlin, Claude B

    Abdominal radiology (New York)

    2018  Volume 44, Issue 2, Page(s) 482–492

    Abstract: Purpose: To determine the inter-reader agreement of magnetic resonance imaging proton density fat fraction (PDFF) and its longitudinal change in a clinical trial of adults with nonalcoholic steatohepatitis (NASH).: Study type: We performed a ... ...

    Abstract Purpose: To determine the inter-reader agreement of magnetic resonance imaging proton density fat fraction (PDFF) and its longitudinal change in a clinical trial of adults with nonalcoholic steatohepatitis (NASH).
    Study type: We performed a secondary analysis of a placebo-controlled randomized clinical trial of a bile acid sequestrant in 45 adults with NASH. A six-echo spoiled gradient-recalled-echo magnitude-based fat quantification technique was performed at 3 T. Three independent readers measured MRI-PDFF by placing one primary and two additional regions of interest (ROIs) in each segment at both time points. Cross-sectional agreement between the three readers was evaluated using intra-class correlation coefficients (ICCs) and coefficients of variation (CV). Additionally, we used Bland-Altman analyses to examine pairwise agreement between the three readers at baseline, end of treatment (EOT), and for longitudinal change.
    Results: Using all ROIs by all readers, mean PDFF at baseline, at EOT, and mean change in PDFF was 16.1%, 16.0%, and 0.07%, respectively. The 27-ROI PDFF measurements had 0.998 ICC and 1.8% CV at baseline, 0.998 ICC and 1.8% CV at EOT, and 0.997 ICC for longitudinal change. The 9-ROI PDFF measurements had corresponding values of 0.997 and 2.6%, 0.996 and 2.4%, and 0.994. Using 27 ROIs, the magnitude of the bias between readers for whole-liver PDFF measurement ranged from 0.03% to 0.06% points at baseline, 0.01% to 0.07% points at EOT, and 0.01% to 0.02% points for longitudinal change.
    Conclusion: Inter-reader agreement for measuring whole-liver PDFF and its longitudinal change is high. 9-ROI measurements have only slightly lower agreement than 27-ROI measurements.
    MeSH term(s) Adipose Tissue/diagnostic imaging ; Adipose Tissue/pathology ; Cross-Sectional Studies ; Female ; Humans ; Image Interpretation, Computer-Assisted/methods ; Liver/diagnostic imaging ; Liver/pathology ; Longitudinal Studies ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Non-alcoholic Fatty Liver Disease/diagnostic imaging ; Non-alcoholic Fatty Liver Disease/pathology ; Observer Variation ; Prospective Studies ; Protons
    Chemical Substances Protons
    Language English
    Publishing date 2018-08-20
    Publishing country United States
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
    ZDB-ID 2839786-1
    ISSN 2366-0058 ; 2366-004X
    ISSN (online) 2366-0058
    ISSN 2366-004X
    DOI 10.1007/s00261-018-1745-3
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  8. Article ; Online: Liver fat imaging-a clinical overview of ultrasound, CT, and MR imaging.

    Zhang, Yingzhen N / Fowler, Kathryn J / Hamilton, Gavin / Cui, Jennifer Y / Sy, Ethan Z / Balanay, Michelle / Hooker, Jonathan C / Szeverenyi, Nikolaus / Sirlin, Claude B

    The British journal of radiology

    2018  Volume 91, Issue 1089, Page(s) 20170959

    Abstract: Hepatic steatosis is a frequently encountered imaging finding that may indicate chronic liver disease, the most common of which is non-alcoholic fatty liver disease. Non-alcoholic fatty liver disease is implicated in the development of systemic diseases ... ...

    Abstract Hepatic steatosis is a frequently encountered imaging finding that may indicate chronic liver disease, the most common of which is non-alcoholic fatty liver disease. Non-alcoholic fatty liver disease is implicated in the development of systemic diseases and its progressive phenotype, non-alcoholic steatohepatitis, leads to increased liver-specific morbidity and mortality. With the rising obesity epidemic and advent of novel therapeutics aimed at altering metabolism, there is a growing need to quantify and monitor liver steatosis. Imaging methods for assessing steatosis range from simple and qualitative to complex and highly accurate metrics. Ultrasound may be appropriate in some clinical instances as a screening modality to identify the presence of abnormal liver morphology. However, it lacks sufficient specificity and sensitivity to constitute a diagnostic modality for instigating and monitoring therapy. Newer ultrasound techniques such as quantitative ultrasound show promise in turning qualitative assessment of steatosis on conventional ultrasound into quantitative measurements. Conventional unenhanced CT is capable of detecting and quantifying moderate to severe steatosis but is inaccurate at diagnosing mild steatosis and involves the use of radiation. Newer CT techniques, like dual energy CT, show potential in expanding the role of CT in quantifying steatosis. MRI proton-density fat fraction is currently the most accurate and precise imaging biomarker to quantify liver steatosis. As such, proton-density fat fraction is the most appropriate noninvasive end point for steatosis reduction in clinical trials and therapy response assessment.
    MeSH term(s) Humans ; Liver/diagnostic imaging ; Magnetic Resonance Imaging ; Non-alcoholic Fatty Liver Disease/diagnostic imaging ; Tomography, X-Ray Computed ; Ultrasonography
    Language English
    Publishing date 2018-06-06
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2982-8
    ISSN 1748-880X ; 0007-1285
    ISSN (online) 1748-880X
    ISSN 0007-1285
    DOI 10.1259/bjr.20170959
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  9. Article ; Online: In vivo breath-hold (1) H MRS simultaneous estimation of liver proton density fat fraction, and T1 and T2 of water and fat, with a multi-TR, multi-TE sequence.

    Hamilton, Gavin / Middleton, Michael S / Hooker, Jonathan C / Haufe, William M / Forbang, Nketi I / Allison, Matthew A / Loomba, Rohit / Sirlin, Claude B

    Journal of magnetic resonance imaging : JMRI

    2015  Volume 42, Issue 6, Page(s) 1538–1543

    Abstract: Purpose: To examine the intra-examination repeatability of proton density fat fraction (PDFF) and T1 and T2 of liver water and fat as estimated by a novel multi-repetition time (TR)-echo time (TE) (1) H magnetic resonance spectroscopy (MRS)-stimulated ... ...

    Abstract Purpose: To examine the intra-examination repeatability of proton density fat fraction (PDFF) and T1 and T2 of liver water and fat as estimated by a novel multi-repetition time (TR)-echo time (TE) (1) H magnetic resonance spectroscopy (MRS)-stimulated echo acquisition mode (STEAM) sequence that acquires 32 spectra for a range of TRs and TEs in single breath-hold.
    Materials and methods: Sixty-seven subjects undergoing liver MRI examinations at 3T had three multi-TR-TE sequences acquired consecutively in a single session. This sequence was designed to allow accurate estimation of T1 and T2 of both water and fat, as well as PDFF, in a single breath-hold. A standard long-TR, multi-TE sequence was also acquired to allow comparison of estimated PDFF. Regression and interclass correlation (ICC) analyses were performed.
    Results: There was strong agreement between PDFF estimated by the multi-TR-TE and long-TR, multi-TE sequences (slope 0.997; intercept -0.03; R = 0.997). The multi-TR-TE sequence had high repeatability for estimating PDFF (ICC = 0.999), water T2 (ICC = 0.920), water T1 (ICC = 0.845), and fat T2 (ICC = 0.760), and moderate repeatability for estimating fat T1 (ICC = 0.556).
    Conclusion: A novel multi-TR-TE sequence can estimate PDFF and water and fat T1 and T2 in a single breath-hold. Refinement may be needed to improve repeatability for fat T1 estimation.
    MeSH term(s) Adipose Tissue/metabolism ; Adipose Tissue/pathology ; Adiposity ; Algorithms ; Body Water/metabolism ; Breath Holding ; Female ; Humans ; Liver/metabolism ; Liver/pathology ; Male ; Middle Aged ; Non-alcoholic Fatty Liver Disease/metabolism ; Non-alcoholic Fatty Liver Disease/pathology ; Proton Magnetic Resonance Spectroscopy/methods ; Reproducibility of Results ; Sensitivity and Specificity
    Language English
    Publishing date 2015-06-25
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 1146614-5
    ISSN 1522-2586 ; 1053-1807
    ISSN (online) 1522-2586
    ISSN 1053-1807
    DOI 10.1002/jmri.24946
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  10. Article ; Online: Normal range for MR elastography measured liver stiffness in children without liver disease.

    Sawh, Mary Catherine / Newton, Kimberly P / Goyal, Nidhi P / Angeles, Jorge Eduardo / Harlow, Kathryn / Bross, Craig / Schlein, Alexandra N / Hooker, Jonathan C / Sy, Ethan Z / Glaser, Kevin J / Yin, Meng / Ehman, Richard L / Sirlin, Claude B / Schwimmer, Jeffrey B

    Journal of magnetic resonance imaging : JMRI

    2019  Volume 51, Issue 3, Page(s) 919–927

    Abstract: Background: Magnetic resonance elastography (MRE) can determine the presence and stage of liver fibrosis. Data on normative MRE values, while reported in adults, are limited in children.: Purpose: To determine the distribution of MRE-measured liver ... ...

    Abstract Background: Magnetic resonance elastography (MRE) can determine the presence and stage of liver fibrosis. Data on normative MRE values, while reported in adults, are limited in children.
    Purpose: To determine the distribution of MRE-measured liver stiffness in children without liver disease.
    Study type: Prospective, observational.
    Population: Eighty-one healthy children (mean 12.6 ± 2.6 years, range 8-17 years).
    Field strength/sequence: 3.0T Signa HDxt, General Electric MR Scanner; 2D GRE MRE sequence.
    Assessment: History, examination, laboratory evaluation, and (MR) exams (proton density fat fraction, PDFF, and MRE) were performed. MR elastograms were analyzed manually at two reading centers and compared with each other for agreement and with published values in healthy adults and thresholds for fibrosis in adult and pediatric patients.
    Statistical tests: Descriptive statistics, Bland-Altman analysis, t-test to compare hepatic stiffness values with reference standards.
    Results: Stiffness values obtained at both reading centers were similar, without significant bias (P = 0.362) and with excellent correlation (intraclass correlation coefficient [ICC] = 0.782). Mean hepatic stiffness value for the study population was 2.45 ± 0.35 kPa (95
    Data conclusion: Mean liver stiffness measured with MRE in this cohort was significantly higher than that reported in healthy adults. Despite rigorous screening, some healthy children had stiffness measurements suggestive of liver fibrosis using current published thresholds. Although MRE has the potential to provide noninvasive assessment in patients with suspected hepatic disease, further refinement of this technology will help advance its use as a diagnostic tool for evidence of fibrosis in pediatric populations.
    Level of evidence: 1 Technical Efficacy: 5 J. Magn. Reson. Imaging 2020;51:919-927.
    MeSH term(s) Adult ; Child ; Echo-Planar Imaging ; Elasticity Imaging Techniques ; Humans ; Liver/diagnostic imaging ; Liver/pathology ; Liver Cirrhosis/diagnostic imaging ; Liver Cirrhosis/pathology ; Liver Diseases/pathology ; Magnetic Resonance Imaging ; Prospective Studies ; Reference Values ; Reproducibility of Results
    Language English
    Publishing date 2019-08-27
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 1146614-5
    ISSN 1522-2586 ; 1053-1807
    ISSN (online) 1522-2586
    ISSN 1053-1807
    DOI 10.1002/jmri.26905
    Database MEDical Literature Analysis and Retrieval System OnLINE

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