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Objective To investigate the value of multi?arterial phase differential sub?sampling with cartesian ordering (DISCO) technique in the evaluation of hepatic vascular anatomy with gadolinium?ethoxybenzyl?diethylenetriamine pentaacetic acid (Gd?EOB?DTPA). Methods Forty?eight patients with suspected hepatic malignancy were prospectively enrolled and underwent both of Gd?EOB?DTPA enhanced DISCO MRI and CTA within two weeks. The hepatic arterial anatomy of two examination methods were evaluated by four?point scoring method. The arterial scores between DISCO and CTA images were compared by Wilcoxon test. The difference among multiple arterial scores of DISCO and CTA were compared by Kruskal?Wallis H test respectively. Results There was no difference of arterial scores in celiac artery, common hepatic artery, proper hepatic artery, left hepatic artery, right hepatic artery, first branch of right hepatic artery, splenic artery, left gastric artery and gastroduodenal artery between DISCO and CTA (P>0.05), but the arterial score of first branch of left hepatic artery [2 (2,2)] was lower than that of CTA [2 (2,3)] (Z=-3.138,P=0.002). In the multiple comparison among different arteries, there were differences between PHA and LAH (P<0.05), B?LHA and B?RHA (P<0.05) in DISCO, but no difference was found in CTA (P>0.05). Conclusion The DISCO sequence with Gd?EOB?DTPA enhancement MRI can supply comparable image quality to CTA in hepatic artery and its main branches display, which has no ionizing radiation and can also provide more diagnostic information for clinic.
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Objective To investigate the quantitative evaluation efficiency of gadolinium?ethoxybenzyl?diethylenetriamine pentaacetic acid (Gd?EOB?DTPA) enhanced T1 mapping in staging hepatic fibrosis caused by viral hepatitis B. Methods One hundred and fifty patients with chronic hepatitis B were prospectively enrolled in Shanghai Public Health Clinical Center, Fudan University from August 2016 to August 2018.These patients underwent liver aspiration biopsy were divided into four subgroups: S1 (n=38), S2 (n=30), S3 (n=33), S4 (n=49) according to Scheuer?Ludwig scoring system. Non?enhanced and Gd?EOB?DTPA?enhanced MRI were performed in all subjects. Look?Locker sequences were performed to acquire T1 mapping of pre and post?contrast at 20 minutes after Gd?EOB?DTPA administration. The T1 value after 20 minutes of Gd?EOB?DTPA administration (T1 20 min), the reduction rate of T1 value (ΔT1 20 min% ), the increase of 1/T1 value (ΔR1 20 min% ) were measured and calculated. The one?way ANOVA was applied to compare the difference in T1 20 min, ΔT1 20 min%, ΔR1 20 min% of various fibrosis stages. ROC curves were used to assess the efficacy of T1 20 min, ΔT1 20 min%, ΔR1 20 min% for diagnosing≥S2,≥S3,≥S4. P<0.05 was considered to be statistically significant. Results The T1 20 min raised with fibrosis stage increased, ΔT1 20 min% and ΔR1 20 min% reduced with fibrosis stage increased. Areas under the curves of T1 20 min, ΔT1 20 min%, ΔR1 20 min% for diagnosing≥S2 were 0.844, 0.905, 0.869; and diagnosing≥S3 were 0.832, 0.907, 0.862; and diagnosing≥S4 were 0.853, 0.897, 0.873, respectively. The diagnostic efficiency of ΔT1 20 min% was the best. Conclusion Gd?EOB?DTPA?enhanced T1 mapping could be regarded as a reliable diagnostic tool for the evaluation of hepatic fibrosis caused by viral hepatitis B.
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ObjectiveTo investigate the feasibility of a combination of gadolinium?ethoxybenzyl?diethylenetriamine pentaacetic acid (Gd?EOB?DTPA) enhanced MR T1 mapping and liver volume to standard liver volume ratio in quantitative assessment of liver function. Methods Eighty patients who underwent Gd?EOB?DTPA enhanced MR T1 mapping were prospectively enrolled, and the Child?Pugh score and the model for end?stage liver (MELD) score were evaluated and grouped. Patients were divided into three groups according Child?pugh score as follows: normal liver function (NLF, n=26), liver cirrhosis with Child?Pugh A (LCA,n=30), liver cirrhosis with Child?Pugh B+C (LCB+LCC, n=24), and were also divided into two groups according MELD, MELD≤8 (n=57) and MELD≥9 (n=23). Variable flip angle T1 mapping sequences were performed before and 20 minutes after Gd?EOB?DTPA administration. T1pre, T1 post were measured on T1 maps and ΔT1 were calculated. The images of hepatobiliary phase were transferred to the workstation to measure liver volume (LV). Standard liver volume (SLV) were calculated with the heights and weights of patients, and then liver volume to standard liver volume ratio (LV/SLV) was calculated. One?way ANOVA was used to compared the indexes (T1 post, T1 post×LV/SLV, ΔT1, ΔT1×LV/SLV) in different liver function groups of NLF,LCA,LCB+LCC. The t tests were used to compare the indexes(T1post, T1post×LV/SLV, ΔT1, ΔT1×LV/SLV) in MELD≤8 and MELD≥9 groups. ROC curve analysis was used to compare the diagnostic performance of T1post, T1post×LV/SLV, ΔT1, ΔT1×LV/SLV. Results T1post, T1post×LV/SLV, ΔT1, ΔT1×LV/SLV showed significant difference between different liver function groups (P<0.05). All the indexes can distinguish different groups. Multiplied by LV/SLV,the AUC of ΔT1×LV/SLV were 0.902 in the MELD≤8 and MELD≥9,which was slightly higher than that of ΔT1 (AUC=0.886). The AUCs of ΔT1×LV/SLV were 0.771, 1.000, 0.924 in the NLF and LCA, NLF and LCB+LCC, LCA and LCB+LCC groups, which were slightly higher than that of ΔT1 (0.764, 0.992, 0.904). The AUCs of T1post, T1post×LV/SLV were 0.824, 0.789 in the MELD≤8 and MELD≥9, respectively. The AUCs of T1post in the NLF and LCA, NLF and LCB+LCC, LCA and LCB+LCC groups were 0.713,0.987,0.915, respectively, and the AUCs of T1post×LV/SLV were 0.687,0.973,0.871.The AUCs of T1post×LV/SLV had a slightly lower AUC amongthe different liver function groups than T1post. Conclusion Gd?EOB?DTPA enhanced MRI T1 mapping is useful for estimating liver function. T1 relaxation times and reduction rates of T1 relaxation times with a combination of the LV/SLV may more reliably estimate liver function.
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Objective To investigate the application value of multiple?arterial?phase imaging technique with differential sub?sampling with cartesian ordering (DISCO) in the gadoxetate acid disodium enhanced liver MRI. Methods From September 2017 to March 2018, 56 patients with suspected malignant focal liver disease diagnosed with ultrasound or CT in West China Hospital of Sichuan University were enrolled prospectively, and underwent preoperative enhanced MRI with gadoxetate acid disodium. Patients were divided into 2 groups by random?number table method. Twenty nine patients in group A underwent liver multiple?arterial?phase imaging with DISCO. Twenty seven patients in group B underwent single?arterial?phase imaging with liver acquisition with volume acceleration?flex (LAVA?Flex). The display rate of late?arterial?phase and respiratory motion artifacts of dynamic enhancement images were evaluated. The categorical variables was compared by Chi?square test. The respiratory motion artifacts between the single?arterial?phase and multiple?arterial?phases were compared by Mann?Whitney U test. The artifact scores among the various phases of the multi?arterial phase were compared by Kruskal?Wallis H. Results Compared to LAVA?Flex [74.1%(20/27)], a higher display rate of late?arterial phase [96.6%(28/29)] was found in DISCO (Group A), and the difference was statistically significant (χ2=5.770, P=0.016). In the evaluation of respiratory motion artifacts, the motion artifacts of the late?arterial images obtained by LAVA?Flex [3(3,4)] were more severe than the DISCO [2(2,3)], and the difference was statistically significant (Z=-3.250, P<0.01). Among the scores of motion artifacts in the 6 phases of DISCO, the artifact scores of phase 1, 2, 3, 4, 5, 6 were [3(3,4)], [2(2,3)], [2(2,3)], [3(2,3)], [3(3,4)] and [3(3,4)], respectively. The motion artifacts of phase 2, 3, 4 were better than phase 1, 5, 6, the differences were statistically significant (P<0.05), but there was no statistical differences among phase 2, 3 and 4 (P>0.05). Conclusion Compared with single?arterial?phase imaging, multiple?arterial?phases with DISCO using gadoxetate acid disodium can improve the capture rate of late arterial phase and reduce motion artifacts.
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Objective To explore the values of metrics on intravoxel incoherent motion (IVIM) and gadoxetic acid enhanced T1ρ imaging for staging of non?alcoholic fatty liver disease activity scores (NAS) and inflammation in nonalcoholic steatohepatitis (NASH) rabbits model. Methods NASH rabbits model was established by feeding with a varied duration (4, 8, 12 weeks) of high?fat, high?cholesterol diet. IVIM and gadolinium?ethoxybenzyl?diethylenetriamine pentaacetic acid (Gd?EOB?DTPA) enhanced T1ρ images were performed by a 3.0 T MR scanner. The inter?class correlation coefficients (ICC) and Bland?Altman analysis were applied to evaluate the reproducibility of the IVIM and Gd?EOB?DTPA enhanced T1ρ mapping measurers. Spearman correlation analysis were used to assess the correlation between MR metrics, including ADC, D, D*, f, T1ρ, T1ρ (hepatobiliary phase, HBP), and NAS score and inflammation grades respectively with reference to histopathology. ROC curve analysis was used to evaluate the diagnostic performance of T1ρ and IVIM parameters for NASH, inflammation grade, and hepatic fibrosis. Multiple linear regression equations were used to analyze the independent influence factors of T1ρ (HBP). Results The f value was negatively correlated with the NAS score (r=-0.530, P<0.01). The f value of the fibrosis S1?2 was significantly lower than that of the S0 (P<0.01). There was no statistical difference in D, D*, ADC among NASH score, inflammation, and fibrosis stage. T1ρ and T1ρ (HBP) values were positively correlated with NAS scores and inflammation grades. The area under curve (AUC) for the diagnosis of NASH for T1ρ, T1ρ(HBP), ADC, D, D*, and f values were 0.849, 0.949, 0.728, 0.596, 0.522, and 0.871, respectively. The AUCs of T1ρ (HBP)+f in the diagnosis of NASH, G2?3 inflammation, and F1?2 fibrosis were 0.971, 0.935, and 0.903, respectively. Fibrosis (R2=0.624, P=0.002) and inflammation (R2=0.746, P=0.002) were major independent factors of T1ρ (HBP). Conclusion Gd?EOB?DTPA enhanced T1ρ imaging can reflect the severity of NASH and degree of inflammation. IVIM measurements are not accurate enough to stage liver inflammatory activity of NASH. T1ρ (HBP)+f might be a superior noninvasive imaging biomarker than either non?enhanced T1ρ or IVIM for NASH activity and inflammation assessments.
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Objective@#To investigate the value of multi-arterial phase differential sub-sampling with cartesian ordering (DISCO) technique in the evaluation of hepatic vascular anatomy with gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA).@*Methods@#Forty-eight patients with suspected hepatic malignancy were prospectively enrolled and underwent both of Gd-EOB-DTPA enhanced DISCO MRI and CTA within two weeks. The hepatic arterial anatomy of two examination methods were evaluated by four-point scoring method. The arterial scores between DISCO and CTA images were compared by Wilcoxon test. The difference among multiple arterial scores of DISCO and CTA were compared by Kruskal-Wallis H test respectively.@*Results@#There was no difference of arterial scores in celiac artery, common hepatic artery, proper hepatic artery, left hepatic artery, right hepatic artery, first branch of right hepatic artery, splenic artery, left gastric artery and gastroduodenal artery between DISCO and CTA (P>0.05), but the arterial score of first branch of left hepatic artery [2 (2,2)] was lower than that of CTA [2 (2,3)] (Z=-3.138,P=0.002). In the multiple comparison among different arteries, there were differences between PHA and LAH (P<0.05), B-LHA and B-RHA (P<0.05) in DISCO, but no difference was found in CTA (P>0.05).@*Conclusion@#The DISCO sequence with Gd-EOB-DTPA enhancement MRI can supply comparable image quality to CTA in hepatic artery and its main branches display, which has no ionizing radiation and can also provide more diagnostic information for clinic.
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Objective@#To investigate the quantitative evaluation efficiency of gadolinium- ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced T1 mapping in staging hepatic fibrosis caused by viral hepatitis B.@*Methods@#One hundred and fifty patients with chronic hepatitis B were prospectively enrolled in Shanghai Public Health Clinical Center, Fudan University from August 2016 to August 2018.These patients underwent liver aspiration biopsy were divided into four subgroups: S1 (n=38), S2 (n=30), S3 (n=33), S4 (n=49) according to Scheuer-Ludwig scoring system. Non-enhanced and Gd-EOB-DTPA-enhanced MRI were performed in all subjects. Look-Locker sequences were performed to acquire T1 mapping of pre and post-contrast at 20 minutes after Gd-EOB-DTPA administration. The T1 value after 20 minutes of Gd-EOB-DTPA administration (T1 20 min), the reduction rate of T1 value (ΔT1 20 min%), the increase of 1/T1 value (ΔR1 20 min%) were measured and calculated. The one-way ANOVA was applied to compare the difference in T1 20 min, ΔT1 20 min%, ΔR1 20 min% of various fibrosis stages. ROC curves were used to assess the efficacy of T1 20 min, ΔT1 20 min%, ΔR1 20 min% for diagnosing ≥ S2, ≥ S3, ≥ S4. P<0.05 was considered to be statistically significant.@*Results@#The T1 20 min raised with fibrosis stage increased, ΔT1 20 min% and ΔR1 20 min% reduced with fibrosis stage increased. Areas under the curves of T1 20 min, ΔT1 20 min%, ΔR1 20 min% for diagnosing ≥ S2 were 0.844, 0.905, 0.869; and diagnosing ≥ S3 were 0.832, 0.907, 0.862; and diagnosing ≥ S4 were 0.853, 0.897, 0.873, respectively. The diagnostic efficiency of ΔT1 20 min% was the best.@*Conclusion@#Gd-EOB-DTPA-enhanced T1 mapping could be regarded as a reliable diagnostic tool for the evaluation of hepatic fibrosis caused by viral hepatitis B.
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Objective@#To investigate the feasibility of a combination of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced MR T1 mapping and liver volume to standard liver volume ratio in quantitative assessment of liver function.@*Methods@#Eighty patients who underwent Gd-EOB-DTPA enhanced MR T1 mapping were prospectively enrolled, and the Child-Pugh score and the model for end-stage liver (MELD) score were evaluated and grouped. Patients were divided into three groups according Child-pugh score as follows: normal liver function (NLF, n=26), liver cirrhosis with Child-Pugh A (LCA,n=30), liver cirrhosis with Child-Pugh B+C (LCB+LCC, n=24), and were also divided into two groups according MELD, MELD≤8 (n=57) and MELD≥9 (n=23). Variable flip angle T1 mapping sequences were performed before and 20 minutes after Gd-EOB-DTPA administration. T1pre, T1 post were measured on T1 maps and ΔT1 were calculated. The images of hepatobiliary phase were transferred to the workstation to measure liver volume (LV). Standard liver volume (SLV) were calculated with the heights and weights of patients, and then liver volume to standard liver volume ratio (LV/SLV) was calculated. One-way ANOVA was used to compared the indexes (T1post, T1 post×LV/SLV, ΔT1, ΔT1×LV/SLV) in different liver function groups of NLF,LCA,LCB+LCC. The t tests were used to compare the indexes (T1post, T1post×LV/SLV, ΔT1, ΔT1×LV/SLV) in MELD≤8 and MELD≥9 groups. ROC curve analysis was used to compare the diagnostic performance of T1post, T1post×LV/SLV, ΔT1, ΔT1×LV/SLV.@*Results@#T1post, T1post×LV/SLV, ΔT1, ΔT1×LV/SLV showed significant difference between different liver function groups (P<0.05). All the indexes can distinguish different groups. Multiplied by LV/SLV,the AUC of ΔT1×LV/SLV were 0.902 in the MELD≤8 and MELD≥9,which was slightly higher than that of ΔT1 (AUC=0.886). The AUCs of ΔT1×LV/SLV were 0.771, 1.000, 0.924 in the NLF and LCA, NLF and LCB+LCC, LCA and LCB+LCC groups, which were slightly higher than that of ΔT1 (0.764, 0.992, 0.904). The AUCs of T1post, T1post×LV/SLV were 0.824, 0.789 in the MELD≤8 and MELD≥9, respectively. The AUCs of T1post in the NLF and LCA, NLF and LCB+LCC, LCA and LCB+LCC groups were 0.713,0.987,0.915, respectively, and the AUCs of T1post×LV/SLV were 0.687,0.973,0.871.The AUCs of T1post×LV/SLV had a slightly lower AUC amongthe different liver function groups than T1post.@*Conclusion@#Gd-EOB-DTPA enhanced MRI T1 mapping is useful for estimating liver function. T1 relaxation times and reduction rates of T1 relaxation times with a combination of the LV/SLV may more reliably estimate liver function.
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Objective@#To investigate the application value of multiple-arterial-phase imaging technique with differential sub-sampling with cartesian ordering (DISCO) in the gadoxetate acid disodium enhanced liver MRI.@*Methods@#From September 2017 to March 2018, 56 patients with suspected malignant focal liver disease diagnosed with ultrasound or CT in West China Hospital of Sichuan University were enrolled prospectively, and underwent preoperative enhanced MRI with gadoxetate acid disodium. Patients were divided into 2 groups by random-number table method. Twenty nine patients in group A underwent liver multiple-arterial-phase imaging with DISCO. Twenty seven patients in group B underwent single-arterial-phase imaging with liver acquisition with volume acceleration-flex (LAVA-Flex). The display rate of late-arterial-phase and respiratory motion artifacts of dynamic enhancement images were evaluated. The categorical variables was compared by Chi-square test. The respiratory motion artifacts between the single-arterial-phase and multiple-arterial-phases were compared by Mann-Whitney U test. The artifact scores among the various phases of the multi-arterial phase were compared by Kruskal-Wallis H.@*Results@#Compared to LAVA-Flex [74.1%(20/27)], a higher display rate of late-arterial phase [96.6%(28/29)] was found in DISCO (Group A), and the difference was statistically significant (χ2=5.770, P=0.016). In the evaluation of respiratory motion artifacts, the motion artifacts of the late-arterial images obtained by LAVA-Flex [3(3,4)] were more severe than the DISCO [2(2,3)], and the difference was statistically significant (Z=-3.250, P<0.01). Among the scores of motion artifacts in the 6 phases of DISCO, the artifact scores of phase 1, 2, 3, 4, 5, 6 were [3(3,4)], [2(2,3)], [2(2,3)], [3(2,3)], [3(3,4)] and [3(3,4)], respectively. The motion artifacts of phase 2, 3, 4 were better than phase 1, 5, 6, the differences were statistically significant (P<0.05), but there was no statistical differences among phase 2, 3 and 4 (P>0.05).@*Conclusion@#Compared with single-arterial-phase imaging, multiple-arterial-phases with DISCO using gadoxetate acid disodium can improve the capture rate of late arterial phase and reduce motion artifacts.
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Objective@#To explore the values of metrics on intravoxel incoherent motion (IVIM) and gadoxetic acid enhanced T1ρ imaging for staging of non-alcoholic fatty liver disease activity scores (NAS) and inflammation in nonalcoholic steatohepatitis (NASH) rabbits model.@*Methods@#NASH rabbits model was established by feeding with a varied duration (4, 8, 12 weeks) of high-fat, high-cholesterol diet. IVIM and gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced T1ρ images were performed by a 3.0 T MR scanner. The inter-class correlation coefficients (ICC) and Bland-Altman analysis were applied to evaluate the reproducibility of the IVIM and Gd-EOB-DTPA enhanced T1ρ mapping measurers. Spearman correlation analysis were used to assess the correlation between MR metrics, including ADC, D, D*, f, T1ρ, T1ρ (hepatobiliary phase, HBP), and NAS score and inflammation grades respectively with reference to histopathology. ROC curve analysis was used to evaluate the diagnostic performance of T1ρ and IVIM parameters for NASH, inflammation grade, and hepatic fibrosis. Multiple linear regression equations were used to analyze the independent influence factors of T1ρ (HBP).@*Results@#The f value was negatively correlated with the NAS score (r=-0.530, P<0.01). The f value of the fibrosis S1-2 was significantly lower than that of the S0 (P<0.01). There was no statistical difference in D, D*, ADC among NASH score, inflammation, and fibrosis stage. T1ρ and T1ρ (HBP) values were positively correlated with NAS scores and inflammation grades. The area under curve (AUC) for the diagnosis of NASH for T1ρ, T1ρ(HBP), ADC, D, D*, and f values were 0.849, 0.949, 0.728, 0.596, 0.522, and 0.871, respectively. The AUCs of T1ρ (HBP)+f in the diagnosis of NASH, G2-3 inflammation, and F1-2 fibrosis were 0.971, 0.935, and 0.903, respectively. Fibrosis (R2=0.624, P=0.002) and inflammation (R2=0.746, P=0.002) were major independent factors of T1ρ (HBP).@*Conclusion@#Gd-EOB-DTPA enhanced T1ρ imaging can reflect the severity of NASH and degree of inflammation. IVIM measurements are not accurate enough to stage liver inflammatory activity of NASH. T1ρ (HBP)+f might be a superior noninvasive imaging biomarker than either non-enhanced T1ρ or IVIM for NASH activity and inflammation assessments.