ISMRM 24th Annual Meeting & Exhibition • 07-13 May 2016 • Singapore

Scientific Session: Hepatobiliary 1: Liver Perfusion/Flow & Function

Monday, May 9, 2016
Summit 1
14:15 - 16:15
Moderators: Claude Sirlin, Alejandro Roldán-Alzate

MR elastography and DCE-MRI of the liver and spleen for non-invasive prediction of portal pressure - Permission Withheld
Stefanie Hectors1, Mathilde Wagner1, Octavia Bane1, Aaron Fischman2, Thomas Schiano3, and Bachir Taouli1,4
1Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States, 2Department of Interventional Radiology, Icahn School of Medicine at Mount SInai, New York, NY, United States, 3Department of Internal Medicine, Icahn School of Medicine at Mount SInai, New York, NY, United States, 4Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
The goal of this study was to assess whether DCE-MRI parameters and MR elastography-derived stiffness in liver and spleen can predict portal pressure. Liver time-to-peak (TTP), mean transit time (MTT), upslope and stiffness (LS) all significantly correlated with hepatic venous pressure gradient (HVPG) measurement. Sensitivity-specificity of LS for detection of HVPG≥5mmHg and HVPG≥10mmHg were 64%-91% and 71%-89% respectively, while combined LS and spleen TTP yielded the highest sensitivity-specificity (92%-86% for HVPG≥5mmHg, 100%-92% for HVPG≥10mmHg). These results indicate that combination of liver and spleen perfusion and stiffness metrics into a multiparametric analysis maximizes diagnostic performance for the prediction of portal pressure.

Longitudinal assessment of structural and haemodynamic parameters in compensated cirrhosis using Quantitative Magnetic Resonance Imaging
Chris Bradley1, Eleanor F Cox1, David Harman2, Martin W James2, Guru P Aithal2, I Neil Guha2, and Susan T Francis1
1Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom, 2NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases, University of Nottingham, Nottingham, United Kingdom
We perform a longitudinal 3 year study to assess progression of disease in compensated cirrhosis (CC) using annual haemodynamic and structural MR measures, and compare with a healthy volunteer group. Longitudinal relaxation time (T1) correlates with liver disease severity, and shows a small variance across years in stable, compensated cirrhosis. In contrast a large variance is shown for liver stiffness measures using Fibroscan®. MR measures correlate well with Enhanced Liver Fibrosis (ELF) scores. This study suggests that MR provides a sensitive technique to assess changes in pathophysiology of CC.

Hemodynamic Changes in the Portal Circulation in Living Related Liver Donors, Assessed by 4D flow MRI - Permission Withheld
Alejandro Roldán-Alzate1,2, Luis A Fernandez3, Oliver Wieben2,4, and Scott B Reeder2,4
1Mechanical Engineering, University of Wisconsin - Madison, Madison, WI, United States, 2Radiology, University of Wisconsin - Madison, Madison, WI, United States, 3Surgery, University of Wisconsin - Madison, Madison, WI, United States, 4Medical Physics, University of Wisconsin - Madison, Madison, WI, United States
The purpose of this study was to evaluate hemodynamic changes in the mesenteric and portal circulation of LDLT donors in response to surgical liver resection. Four living related liver donors were studied. Subjects were imaged using 4D Flow MRI before and after liver resection surgery. Highly patient-specific responses to each surgical procedure were found. The ability to quantify hemodynamic changes in the portal and mesenteric circulation non-invasively demonstrates that 4D flow MRI may be a suitable tool for both surgical planning of LDLT, and for improved understanding of the hemodynamic changes that occur in the liver remnant of the donor.

Free-Breathing 3D Liver Perfusion Quantification Using a Dual-Input Two-Compartment Model
Satyam Ghodasara1, Vikas Gulani2, and Yong Chen2
1Case Western Reserve University School of Medicine, Cleveland, OH, United States, 2Radiology, Case Western Reserve University, Cleveland, OH, United States
The dual-input two-compartment model was applied to liver perfusion data, and significant differences in perfusion parameters were found between normal hepatic parenchyma and focal lesions, and also between HCC and metastatic lesions. These findings support the possibility of using a two-compartment model with 3D free-breathing acquisitions, for lesion characterization.

Acceleration of Image Analysis for Liver Perfusion Quantification Using Parallel Computational Techniques
Satyam Ghodasara1, Yong Chen2, Mark Griswold2, Nicole Seiberlich3, and Vikas Gulani2
1Case Western Reserve University School of Medicine, Cleveland, OH, United States, 2Radiology, Case Western Reserve University, Cleveland, OH, United States, 3Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
To make free-breathing liver perfusion quantification feasible for a clinical timescale, acceleration of both non-Cartesian parallel imaging reconstruction and non-rigid image registration was performed with parallel computing techniques. Our results show massively increased speed (12 minutes compared to >22.5 hours for standard computations) with extremely minor differences in both image quality and perfusion quantification.

Measurement of bulk liver perfusion: Assessment of agreement between ASL and caval subtraction phase-contrast MRI at 9.4T
Manil Chouhan1, Rajiv Ramasawmy2, Alan Bainbridge3, Adrienne Campbell-Washburn2, Jack Wells2, Shonit Punwani1, Rajeshwar Mookerjee4, Simon Walker-Samuel2, Mark Lythgoe2, and Stuart Taylor1
1UCL Centre for Medical Imaging, University College London, London, United Kingdom, 2UCL Centre for Advanced Biomedical Imaging, University College London, London, United Kingdom, 3Department of Medical Physics, University College London Hospitals NHS Trust, London, United Kingdom, 4UCL Institute for Liver and Digestive Health, University College London, London, United Kingdom
Non-invasive preclinical liver perfusion measurements could be used to develop biomarkers and assess new treatments for liver disease and primary/secondary malignant liver lesions.  ASL can provide regional hepatic perfusion maps, and in this study we compare FAIR ASL tissue perfusion measurements with caval subtraction phase-contrast MRI, a validated method for measuring total liver blood flow, to demonstrate ASL overestimation but encouraging agreement between both methods.

Quantitative Liver Function Analysis using Volumetric T1 Mapping with Fast Multi-Slice B1 Correction on Hepatocyte-specific Contrast Enhanced Liver Magnetic Resonance Imaging - Permission Withheld
Jeong Hee Yoon1, Jeong Min Lee1, Eun Ju Kim2, Tomoyuki Okuaki3, and Joon Koo Han1
1Radiology, Seoul National University Hospital, Seoul, Korea, Republic of, 2Philips Healthcare, Seoul, Korea, Republic of, 3Philips Healthcare, Tokyo, Japan
Liver signal intensity on hepatobiliary phase at gadoxetic acid-enhanced liver MRI has been reported to be useful to estimate global and regional liver function quantitatively. However, simple MR signal measurement is often suffering from its sensitivity of MR field inhomogeneity and non-linear relationship with contrast medium concentration. Herein, we investigated of B1 correction effect on T1 map and compared its diagnostic performance to assess liver function according to Child-Pugh classification. In addition, we attempted to investigate risk assessment capability of B1 corrected T1 map for long-term clinical outcome in patients with cirrhosis.

Gd-EOB-DTPA-enhanced MRI: evaluation of liver function by multiple hepatocyte-phase images and T1 mapping in rats
Jia Xu1, Xuan Wang1, Yan You2, Qin Wang1, Hui Liu3, Jing Lei1, Huadan Xue1, and Zhengyu Jin1
1Department of Radiology, Peking Union Medical College Hospital, Beijing, China, People's Republic of, 2Department of Pathology, Peking Union Medical College Hospital, Beijing, China, People's Republic of,3Siemens Ltd. China, Shanghai, China, People's Republic of
To evaluate regional liver function preoperatively is of great value in planning surgical management. Our Aim is to investigate the potential of Gd-EOB-DTPA enhanced MRI in evaluating hepatic function in rats with liver fibrosis. Parameters calculated from Gd-EOB-DTPA enhanced MRI exhibited moderate to high correlation with plasma indocyanine green retention rate at 15 minutes after intravenous injection of ICG (ICG R15) in rats with liver fibrosis, indicating its potential in liver function evaluation. 

Comparison of the Hepatocyte Fraction and Conventional Image Based Methods for the Estimation of Liver Function
Tomoyuki Okuaki1, Kosuke Morita2, Tomohiro Namimoto3, Morikatsu Yoshida3, Shinya Shiraishi3, Masanori Komi2, Yasuyuki Yamashita3, and Marc Van Cauteren1
1Philips Healthcare, Tokyo, Japan, 2Department of Central Radiology, Kumamoto University Hospital, Kumamoto, Japan, 3Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
The hepatocyte fraction (HeF) is based on simple pharmacokinetics, and can quantitatively estimate the fraction of hepatocytes. In this study, the HeF, liver-spleen contrast ratio and delta T1 value were compared to the results of 99mTc-GSA scintigraphy using the blood clearance index (HH15) and receptor index (LHL15). The correlation coefficients of the HH15 were 0.602, 0.544 and 0.773, respectively, and of the LHL15 were 0.612, 0.670 and 0.762, respectively. The HeF quantification showed the highest correlation with the 99mTc-GSA, proving it to be useful for a robust evaluation of liver function, compared to conventional imaging based quantitative methods.

The change and interrelation of quantitative hepatic MR imaging biomarkers in the course of chronic hepatitis.
Akira Yamada1, Yasunari Fujinaga1, Yoshihiro Kitoh2, Takeshi Suzuki1, Daisuke Komatsu1, Aya Shiobara2, Yasuo Adachi2, Atsushi Nozaki3, Yuji Iwadate3, Kazuhiko Ueda1, and Masumi Kadoya1
1Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan, 2Division of Radiology, Shinshu University Hospital, Matsumoto, Japan, 3GE Healthcare Japan, Hino, Japan
Variable quantitative hepatic imaging biomarkers including pharmacokinetic parameters of hemodynamics and hepatocellular uptake function, R2* and fat fraction, apparent diffusion coefficient (ADC), liver stiffness were obtained from the patients with chronic hepatitis using MR imaging. The change and interrelation of these imaging biomarkers in the course of chronic hepatitis were evaluated quantitatively. Portal venous inflow and hepatocellular uptake function correlated well with liver stiffness, meanwhile, ADC showed weak correlation. Arterial compensation, decreased blood flow speed and volume were observed in the patients with decreased portal venous inflow. No significant correlation was observed between liver stiffness and R2* or fat fraction.

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