Richard L. Ehman, M.D. Richard L. Ehman, M.D. SCBT·MR Annual Course October 26, 2011 SCBT·MR Annual Course October 26, 2011 MR Elastography: Assessment of Diffuse Liver Disease MR Elastography: Assessment of Diffuse Liver Disease The Mayo Clinic and the presenter have patent rights and a relevant financial interest. The Mayo Clinic and the presenter have patent rights and a relevant financial interest. Disclosure: Disclosure: Compliant with oversight by the Mayo Clinic Conflict of Interest Review Board. Compliant with oversight by the Mayo Clinic Conflict of Interest Review Board. Assurance: Assurance:
11
Embed
MR Elastography MRE for... · Noninvasive Tests • Serum Biomarkers • Direct and Indirect • Conventional Imaging • MRI, US, CT • US Elastography • Fibroscan • ARFI •
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Richard L. Ehman, M.D.Richard L. Ehman, M.D.
SCBT·MR Annual CourseOctober 26, 2011
SCBT·MR Annual CourseOctober 26, 2011
MR Elastography:
Assessment of Diffuse Liver Disease
MR Elastography:
Assessment of Diffuse Liver Disease
The Mayo Clinic and the presenter have patent rights and a relevant financial interest.
The Mayo Clinic and the presenter have patent rights and a relevant financial interest.
Disclosure:Disclosure:
Compliant with oversight by the Mayo Clinic Conflict of Interest Review Board.Compliant with oversight by the Mayo Clinic Conflict of Interest Review Board.
Assurance:Assurance:
Importance of Chronic Liver Disease, Fibrosis, CirrhosisImportance of Chronic Liver Importance of Chronic Liver Disease, Fibrosis, CirrhosisDisease, Fibrosis, Cirrhosis
•• A leading cause of death worldA leading cause of death world--wide wide
•• Increasing prevalence of conditions that Increasing prevalence of conditions that cause hepatic fibrosiscause hepatic fibrosis•• Hepatitis C Hepatitis C -- 170 M people globally170 M people globally•• Hepatitis BHepatitis B•• Obesity / Fatty liver diseaseObesity / Fatty liver disease
•• Fibrosis can be reversed, if diagnosed Fibrosis can be reversed, if diagnosed early and treatedearly and treated
Progression of Liver DiseaseProgression of Liver Disease
Liver BiopsyStandard Diagnostic Procedure to rule-out Fibrosis
Liver BiopsyStandard Diagnostic Procedure to rule-out Fibrosis
• Risk of Complications
• Potential Sampling Errors
• Subjective Histology Grading
• Risk of Complications
• Potential Sampling Errors
• Subjective Histology Grading
NormalNormal FibrosisFibrosis
ReversibleSilent
ReversibleSilent
CirrhosisCirrhosis
IrreversibleHigh mortality
IrreversibleHigh mortality
Noninvasive TestsNoninvasive Tests
• Serum Biomarkers
• Direct and Indirect
• Conventional Imaging
• MRI, US, CT
• US Elastography
• Fibroscan
• ARFI
• MRI Techniques
• Contrast enhanced
• Diffusion-weighted
• MR Elastography
MR ElastographyMR Elastography
2.5cm2.5cm
ConventionalMR Image
ConventionalMR Image
Tissue-simulating gel phantom with
stiff inclusions
3. Inversion3. Inversion
800 40Shear Stiffness (kPa)Shear Stiffness (kPa)
ElastogramElastogram
1. Driver1. Driver(30-500 Hz)(30-500 Hz)
2. MRE Sequence2. MRE Sequence
-10
Wave ImagesWave Images
0 +10Displacement (m)Displacement (m)
Acoustic Driver System for MREAcoustic Driver System for MREAcoustic Driver System for MRE
Sensitivity and Specificity of MRE for Hepatic Fibrosis• Rouviere O, Yin M, Dresner MA, et al. MR elastography of the liver: preliminary results.
Radiology. 2006;240:440-448.
• Huwart L, Peeters F, Sinkus R, et al. Liver fibrosis: non-invasive assessment with MR elastography. NMR Biomed. 2006;19:173-179.
• Yin M, Woollard J, Wang X, et al. Quantitative assessment of hepatic fibrosis in an animal model with magnetic resonance elastography. Mag Reson Med. 2007;58:346-353.
• Salameh N, Peeters F, Sinkus R, et al. Hepatic viscoelastic parameters measured with MR elastography. 2007;26:956-962.
• Yin M, Talwalkar JA, Glaser KJ, et al. Assessment of hepatic fibrosis with magnetic resonance elastography. Clin Gastroenterol Hepatol. 2007;5:1207-1213.
• Huwart L, Sempoux C, Salameh N, et al. Liver fibrosis: Noninvasive assessment with MR elastography versus aspartate aminotransferase-to-platelet ratio index. Radiology. 2007;245:458-466.
• Huwart L, Salameh N, ter Beek L, et al. MR elastography of liver fibrosis: preliminary results comparing spin-echo and echo-planar imaging. Eur Radiol. 2008;18:2535-2541.
• Huwart L, Sempoux C, Vicaut E, et al. Magnetic resonance elastography for the noninvasive staging of liver fibrosis. Gastroenterology. 2008;135:32-40.
• Salameh N, Larrat B, Abarca-Quinones J, et al. Early detection of steatohepatitis in fatty rat liver by using MR elastography. Radiology. 2009;253:90-97.
• Asbauch P, Klatt D, Schlosser B, et al. Viscoelasticity-based staging of hepatic fibrosis with multifrequency MR elastography. Radiology. 2010;257:80-86.
Comparability to Transient Ultrasound Elastography• Oudry J, Chen J, Glaser KJ, et al. Cross-validation of magnetic resonance
elastography and ultrasound-based transient elastography: a preliminary phantom study. J Magn Reson Imaging. 2009;30:1145-50.
Reproducibility• Hines CD, Bley TA, Lindstrom MJ, Reeder SB. Repeatability of magnetic
resonance elastography for quantification of hepatic stiffness. J Magn ResonImaging. 2010;31:725-731.
• Motosugi U, Ichikawa T, Sano K, et al. Magnetic resonance elastography of the liver: preliminary results and estimation of inter-rater reliability. Jpn J Radiol. 2010;28:623-627.
• Hines CD, Lindstrom MJ, Varma AK, Reeder SB. Effects of postprandial state and mesenteric blood flow on the repeatability of MR elastography in asymptomatic subjects. J Magn Reson Imaging. 2011;33:239-244.
• Shire NJ, Yin M, Chen J, et al. Test-Retest Reproducibility of Magnetic Resonance Elastography for Non-Invasive Liver Fibrosis Assessment in Hepatitis C. Submitted.
•• Emerging as a reliable nonEmerging as a reliable non--invasive invasive method for diagnosing hepatic fibrosismethod for diagnosing hepatic fibrosis
•• Safer, less expensive, and less affected Safer, less expensive, and less affected by sampling error than liver biopsyby sampling error than liver biopsy
•• Other potential applications (heart, lung, Other potential applications (heart, lung, pancreas, breast) are being exploredpancreas, breast) are being explored