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      MR imaging in liver cirrhosis: classical and new approaches

      review-article
      Author(s): 1 , 2 , , 1
      Publication date (Electronic):
      Journal: Insights into Imaging
      Publisher: Springer-Verlag
      Keywords: Liver cirrhosis, Liver, MR imaging

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          Abstract

          Objective

          The typical histological features of chronic hepatitis and cirrhosis are variable degrees of hepatocellular necrosis and inflammation (activity or grade of disease), fibrosis (stage of disease), and associated fat and iron deposition. These features influence the liver’s appearance and must be assessed separately by imaging biomarkers in order to be clinically useful. Hepatic morphologic alterations and features of portal hypertension identify most cases of established cirrhosis. Nowadays, research is focused on developing ways to improve detection of early and intermediate stages of fibrosis as well as hepatocyte dysfunction. Even more, most imaging-related measurements are subject to complex interactions and are influenced by different pathologic processes, such as fatty infiltration, edema, necrosis and iron accumulation.

          Methods and results

          MR experience throughout the last 15 years at the Dr Peset University Hospital is reviewed.

          Conclusion

          Nowadays, several biomarkers have been developed to grade the liver status in cirrhosis. This review will focus on these topics.

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          Most cited references43

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          Liver cirrhosis: intravoxel incoherent motion MR imaging--pilot study.

          Alain Rahmouni, Pierre Brugières, Isabelle Ruel … (2008)
          To retrospectively evaluate a respiratory-triggered diffusion-weighted (DW) magnetic resonance (MR) imaging sequence combined with parallel acquisition to allow the calculation of pure molecular-based (D) and perfusion-related (D*, f) diffusion parameters, on the basis of the intravoxel incoherent motion (IVIM) theory, to determine if these parameters differ between patients with cirrhosis and patients without liver fibrosis. The institutional review board approved this retrospective study; informed consent was waived. IVIM DW imaging was tested on three alkane phantoms, on which the signal-intensity decay curves according to b factors were logarithmically plotted. Ten b factors (0, 10, 20, 30, 50, 80, 100, 200, 400, 800 sec/mm(2)) were used in patients. Patients with documented liver cirrhosis (cirrhotic liver group, n = 12) and patients without chronic liver disease (healthy liver group, n = 25) were included. The mean liver D, D*, and f values were measured and compared with the apparent diffusion coefficient (ADC) computed by using four b values (0, 200, 400, 800 sec/mm(2)). Liver ADC and D, f, and D* parameters were compared between the cirrhotic liver group and healthy liver group. Means were compared by using the Student t test. Signal-intensity decay curves were monoexponential on phantoms and biexponential in patients. In vivo, mean ADC values were significantly higher than D in the healthy liver group (ADC = 1.39 x 10(-3) mm(2)/sec +/- 0.2 [standard deviation] vs D = 1.10 x 10(-3) mm(2)/sec +/- 0.7) and in the cirrhotic liver group (ADC = 1.23 x 10(-3) mm(2)/sec +/- 0.4 vs D = 1.19 x 10(-3) mm(2)/sec +/- 0.5) (P = .03). ADC and D* were significantly reduced in the cirrhotic liver group compared with those in the healthy liver group (respective P values of .03 and .008). Restricted diffusion observed in patients with cirrhosis may be related to D* variations, which reflect decreased perfusion, as well as alterations in pure molecular water diffusion in cirrhotic livers. RSNA, 2008
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            Multiecho reconstruction for simultaneous water-fat decomposition and T2* estimation.

            Ann Shimakawa, Giang Vu, J. J. Beatty … (2007)
            To describe and demonstrate the feasibility of a novel multiecho reconstruction technique that achieves simultaneous water-fat decomposition and T2* estimation. The method removes interference of water-fat separation with iron-induced T2* effects and therefore has potential for the simultaneous characterization of hepatic steatosis (fatty infiltration) and iron overload. The algorithm called "T2*-IDEAL" is based on the IDEAL water-fat decomposition method. A novel "complex field map" construct is used to estimate both R2* (1/T2*) and local B(0) field inhomogeneities using an iterative least-squares estimation method. Water and fat are then decomposed from source images that are corrected for both T2* and B(0) field inhomogeneity. It was found that a six-echo multiecho acquisition using the shortest possible echo times achieves an excellent balance of short scan and reliable R2* measurement. Phantom experiments demonstrate the feasibility with high accuracy in R2* measurement. Promising preliminary in vivo results are also shown. The T2*-IDEAL technique has potential applications in imaging of diffuse liver disease for evaluation of both hepatic steatosis and iron overload in a single breath-hold. (c) 2007 Wiley-Liss, Inc.
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              MR Imaging of hepatocellular carcinoma in the cirrhotic liver: challenges and controversies.

              Prasad Adusumilli, J Marrero, Jonathon M Willatt … (2008)
              The incidence of hepatocellular carcinoma (HCC) is expected to increase in the next 2 decades, largely due to hepatitis C infection and secondary cirrhosis. HCC is being detected at an earlier stage owing to the implementation of screening programs. Biopsy is no longer required prior to treatment, and diagnosis of HCC is heavily dependent on imaging characteristics. The most recent recommendations by the American Association for the Study of Liver Diseases (AASLD) state that a diagnosis of HCC can be made if a mass larger than 2 cm shows typical features of HCC (hypervascularity in the arterial phase and washout in the venous phase) at contrast material-enhanced computed tomography or magnetic resonance (MR) imaging or if a mass measuring 1-2 cm shows these features at both modalities. There is an ever-increasing demand on radiologists to detect smaller tumors, when curative therapies are most effective. However, the major difficulty in imaging cirrhosis is the characterization of hypervascular nodules smaller than 2 cm, which often have nonspecific imaging characteristics. The authors present a review of the MR imaging and pathologic features of regenerative nodules and dysplastic nodules and focus on HCC in the cirrhotic liver, with particular reference to small tumors and lesions that may mimic HCC. The authors also review the sensitivity of MR imaging for the detection of these tumors and discuss the staging of HCC and the treatment options in the context of the guidelines of the AASLD and the imaging criteria required by the United Network for Organ Sharing for transplantation. MR findings following ablation and chemoembolization are also reviewed. (c) RSNA, 2008.
              Article 0 comments Cited 65 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                : Luis.Marti@uv.es
                Journal
                Journal ID (nlm-ta): Insights Imaging
                Journal ID (iso-abbrev): Insights Imaging
                Title: Insights into Imaging
                Publisher: Springer-Verlag (Berlin/Heidelberg )
                ISSN (Electronic): 1869-4101
                Publication date (Electronic): 5 August 2010
                Publication date PMC-release: 5 August 2010
                Publication date Collection: September 2010
                Volume: 1
                Issue: 4
                Pages: 233-244
                Affiliations
                [1 ]Department of Radiology, Dr Peset University Hospital, Avda Gaspar Aguilar 90., ES 46017 Valencia, Spain
                [2 ]Department of Radiology, Quirón Hospital, Avda Blasco Ibáñez 14., ES 46010 Valencia, Spain
                Article
                Publisher ID: 34
                DOI: 10.1007/s13244-010-0034-7
                PMC ID: 3259325
                PubMed ID: 22347919
                SO-VID: 9e054efd-a686-4e62-8fda-1ac7334b811d
                Copyright © © European Society of Radiology 2010
                History
                Date received : 16 March 2010
                Date revision received : 29 June 2010
                Date accepted : 12 July 2010
                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © European Society of Radiology 2010

                ScienceOpen disciplines: Radiology & Imaging
                Keywords: liver, mr imaging,liver cirrhosis
                Data availability:
                ScienceOpen disciplines: Radiology & Imaging
                Keywords: liver, mr imaging, liver cirrhosis

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