View Presentation Video

Young-Suk Choi¹ and Ho-Taek Song^2
1Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea, Republic of, ²Yonsei University College of Medicine, Seoul, Korea, Republic of

Keywords: Liver, Hyperpolarized MR (Non-Gas)

Nonalcoholic fatty liver disease and diabetes are known to be closely related, but the mechanism has not been defined yet. The metabolic feature of the diabetic liver is that gluconeogenesis and fatty acid synthesis increase simultaneously. In this study, we hypothesized that ATP citrate lyase (ACLY) would play an essential role in inducing metabolic contradiction in the diabetic liver and investigate ACLY’s role on carbohydrate metabolism using hyperpolarized (HP) 13C pyruvate magnetic resonance spectroscopy (MRS) and primary mouse hepatocytes. 

View Presentation Video

Efe Ozkaya^1,2, Paul Kennedy^1,2, Jun Chen³, Octavia Bane^1,2, Jonathan R. Dillman⁴, Kartik S. Jhaveri⁵, Michael Ohliger ^6,7, Phillip J. Rossman³, Jean A. Tkach⁴, Sudhakar K. Venkatesh³, Richard L. Ehman³, and Bachir Taouli^1,2
1Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States, ²BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States, ³Department of Radiology, Mayo Clinic, Rochester, MN, United States, ⁴Department of Radiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States, ⁵Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, and Women’s College Hospital,, University of Toronto, Toronto, ON, Canada, ⁶Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States, ⁷Department of Radiology, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States

Keywords: Liver, Elastography, Phantom, Multicenter study, Accuracy, Repeatability

The purpose of our multicenter study was to determine the accuracy and test-retest repeatability of stiffness measured with MRE in phantoms. Three phantoms with known stiffness (2.4, 4.4, and 7.5 kPa) were circulated between 5 different centers. 1.5T or 3T systems from the 3 major vendors were used for scanning with 2D GRE and/or SE-EPI MRE sequences. The reference was based on measurements in the reference center made at the start and end of study. For all 3 phantoms the mean accuracy error for the 4 testing centers was 10.2%, while test-retest repeatability error was 2.9% for all centers.

View Presentation Video

Elizabeth Huaroc Moquillaza¹, Kilian Weiss², Yoo Jin Lee³, Jonathan Stelter¹, Thomas Amthor³, Peter Koken³, Marcus R. Makowski¹, Rickmer Braren¹, Mariya Doneva³, and Dimitrios C. Karampinos^1
1Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany, ²Philips GmbH Market DACH, Hamburg, Germany, ³Philips Research Lab, Hamburg, Germany

Keywords: Liver, Relaxometry

Liver T1 mapping can characterize liver alterations in diffuse or focal (e.g. metastatic) liver disease, but it is currently limited to acquisitions of a single-slice per breath-hold. We propose a continuous inversion recovery methodology combining a single-shot gradient echo spiral readout, Dixon processing for water-fat separation and dictionary-based analysis for water selective T1 mapping in the liver at 3T. The spiral readout is employed for a high k-space sampling efficiency, enabling acquisitions with only 1.2s per slice. The method allows multi-slice full-liver water T1 mapping either in a single 11s-breath-hold or in a respiratory-triggered acquisition.

View Presentation Video

Utsav Shrestha¹, Cara Morin^2,3, Ralf Loeffler⁴, Zachary R. Abramson², Jane Hankins², Claudia Hillenbrand⁴, and Aaryani Tipirneni-Sajja^1,2
1The University of Memphis, Memphis, TN, United States, ²St. Jude Children's Research Hospital, Memphis, TN, United States, ³Cincinnati Children’s Hospital Medical Center, CINCINNATI, OH, United States, ⁴University of New South Wales, Sydney, Australia

Keywords: Liver, Liver, Deep Learning, Vessel Segmentation, R2*, HIC

Ultra-short echo time (UTE) imaging increases the accuracy of R2*-based hepatic iron content (HIC) quantification in cases of high iron overload when conventional GRE sequences can fail due to rapid signal decay. Segmenting whole liver to estimate liver R2* requires human expert and is time consuming. In this study, we trained a convolutional neural network (CNN) to automatically segment the liver parenchyma on radial UTE acquisitions using magnitude images and R2* maps. Our results show an excellent agreement between manual and CNN-based liver segmentation and mean R2* values, hence demonstrating the potential of our proposed method for automated HIC assessment.

View Presentation Video

Andrew Duffy¹, Parth Maheta², Andreu F. Costa³, Sharon Clarke^3,4, Ashley Stueck⁵, Magnus McLeod⁶, and James Rioux^2,3,4
1Medicine, Dalhousie University, Halifax, NS, Canada, ²Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada, ³Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada, ⁴Biomedical Translational Imaging Centre, Nova Scotia Health Authority, Halifax, NS, Canada, ⁵Pathology, Dalhousie University, Halifax, NS, Canada, ⁶General Internal Medicine, Dalhousie University, Halifax, NS, Canada

Keywords: Liver, Fat, Fibrosis

There is significant interest in non-invasive biomarkers for staging of liver fibrosis in non-alcoholic fatty liver disease (NAFLD) to reduce the need for biopsy. T1 correlates with fibrosis but can also be influenced by fat, and while Dixon fat-water separation can remove this effect, such methods are uncommon in clinical T1 mapping sequences. In this work, we demonstrate a retrospective correction to estimate the T1 of liver tissue based on MP2RAGE without fat-water separation. This enables fat compensation in a wider range of acquisitions and improves the potential clinical utility of T1 as a biomarker for liver fibrosis.

View Presentation Video

Hailong Li¹, Ziang Chen¹, Jinzhao Qian¹, Wen Pan¹, Scott B. Reeder², David T. Harris², William R. Masch³, Anum Alsam³, Krishna P. Shanbhogue⁴, Anas Bernieh¹, Sarangarajan Ranganathan¹, Nehal A. Parikh¹, Jonathan R. Dillman¹, and Lili He^1
1Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States, ²University of Wisconsin-Madison, Madison, WI, United States, ³Michigan Medicine, University of Michigan, Ann Arbor, MI, United States, ⁴NYU Langone Health, New York, NY, United States

Keywords: Liver, Liver, Liver stiffness

MR elastography (MRE) offers a non-invasive approach to quantify liver stiffening, a surrogate for hepatic fibrosis. However, it has drawbacks, including long exam time, patient discomfort, and the need for additional hardware. The objective of this multi-site study is to develop a machine learning model to categorically stratify the severity of liver stiffness using clinical, routinely collected T2-weighted MRI data from pediatric and adult patients from four study sites. With radiomic features extracted from MRI data, our model achieved an AUROC of 0.72 for stratifying liver stiffness, demonstrating the potential of such a machine learning strategy for clinical utilization. 

View Presentation Video

Jie Zou^1,2,3, Yanli Jiang^1,2,3, Fengxian Fan^1,3, Pin Yang^1,3, Yuan Ding^1,3, Jing Zhang^1,3, Kai Ai⁴, and Zhigang Wu^5
1Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China, ²Second Clinical School, Lanzhou University, Lanzhou, China, ³Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou, China, ⁴Philips Healthcare, Xi'an, China, ⁵Philips Healthcare, Shenzhen, China

Keywords: Liver, Liver, T1rho, chronic liver disease, T1 mapping

The purpose of this study is to evaluate the diagnostic performance of T1 rho and Gd-EOB-DTPA-Enhanced T1 Mapping  in patients with chronic hepatitis B in liver function reserve. For the two groups of Child-Pugh A vs. B/C and Child-Pugh A/ B vs. C, the AUC of T1 rho and T1_post-10min is higher than other metrics. The AUC value combined with these two indicators is the highest (0.861; 0.912). Δ T1, Δ R1 and ECV and T1 rho quantitative techniques may be helpful for staging liver function reserve, and the combination of T1 rho and T1_post-10min can provide higher diagnostic efficiency.

View Presentation Video

Marc Azagra¹, Elisa Pose², Francesco De Chiara³, Martina Pérez², Emma Avitabile², Joan-Marc Servitja⁴, Laura Brugnara⁴, Javier Ramón-Azcón³, and Irene Marco-Rius^1
1MIPMED, IBEC, Barcelona, Spain, ²Liver Unit, Hospital Clínic, Barcelona, Spain, ³Biosensors for Bioengineering, IBEC, Barcelona, Spain, ⁴IDIBAPS, Barcelona, Spain

Keywords: Liver, Blood, Ammonium quantification, chronic liver disease, hepatic dysfunction, disease biomarker, NMR

Invasive and painful liver biopsy is the gold standard for liver disease diagnosis. Non-invasive methods to assess liver fibrosis in patients with alcohol-related liver disease (ArLD) and non-alcoholic fatty liver disease (NAFLD) are an unmet clinical need. We have developed a robust and reliable ¹H NMR protocol to quantify the endogenous ammonium concentration in biological fluids. The measurement of ammonium in blood plasma samples of ArLD and NAFLD patients discerned between some stages of the disease retrospectively and showed that ammonium readout is a robust diagnostic marker of fibrosis stage, more so than current clinically assessed blood hepatic biomarkers.

View Presentation Video

Bogdan Dzyubak¹, Kay M Pepin¹, Jun Chen¹, Yuan Le¹, Kyle Kalutkiewicz², Roger Grimm¹, Jeremy A Heilman¹, Scott Kruse¹, Jennifer Kugel¹, Meng Yin¹, Kevin J Glaser¹, and Ehman L. Richard^1
1Radiology, Mayo Clinic, Rochester, MN, United States, ²Engineering, Resoundant, Rochester, MN, United States

Keywords: Liver, Elastography

Magnetic Resonance Elastography is a technique used to effectively stage liver fibrosis by measuring tissue stiffness. This work optimized several acquisition and processing parameters, and performed a comprehensive repeatability/reproducibility validation across the three types of MRE (GRE, EPI, 3DEPI), 1.5T and 3T field strengths, and the three major manufacturers (GE, Siemens, Philips). When using the optimized methods and automated analysis, the repeatability coefficients were 11.8% for GRE, 10.8% for EPI, and 7.7% for 3DEPI, all superior to QIBA’s 19% benchmark. Agreement between manufacturers was within 2%.

View Presentation Video

Xiang Xu¹, Rodolphe Leforestier¹, Ding Xia¹, and Li Feng^1
1BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Keywords: Liver, Magnetization transfer

We aim to translate the glycogen imaging approach to clinical scanners for human liver imaging. By combining saturation transfer preparation and Golden-angle Radial Sparse Parallel (GRASP) imaging, we can achieve steady-state saturation suitable for generating glycogen nuclear Overhauser enhancement (NOE) contrast and free-breathing imaging readout. Furthermore, we incorporated multi-echo acquisition, enabling NOE quantification in water-only images without fat influence. In this project, we demonstrated the effect of fat signal in z spectra from the composite images and the removal of such effect in z spectra from water only images. We also validated the glycoNOE signal using a fasting protocol.

View Presentation Video

Can Wu¹, Qi Peng², Ramin Jafari³, Yansong Zhao³, Victoria Yu¹, and Ricardo Otazo^1,4
1Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States, ²Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States, ³MR Clinical Science, Philips Healthcare, Cambridge, MA, United States, ⁴Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States

Keywords: Liver, Relaxometry

An efficient diamond radial sampling strategy was proposed for free-breathing 3D T1ρ abdominal imaging at 3T. The phantom experiment shows that diamond radial sampling provides T1ρ measurement values comparable to that of 3D Cartesian and radial stack-of-stars sampling. In-vivo volunteer studies illustrate that diamond radial sampling is superior to Cartesian sampling, where image quality is significantly compromised by breathing motion artifacts. In addition, scan time can be drastically reduced using the fast MAPSS method. This work demonstrates the feasibility of quantitative free-breathing 3D T1ρ imaging with diamond radial sampling in the abdomen.

View Presentation Video

Chao Li¹, Mingkai Li², Xin Jin¹, Mengshi Dong¹, Yu Han¹, Meng Yin³, Jun Chen¹, Kevin J Glaser³, Richard L Ehman³, and Jin Wang^1
1Department of Radiology, The Third Affiliated Hospital, Sun Yat-sen University (SYSU), Guangzhou, China, ²Department of Gastroenterology, The Third Affiliated Hospital, Sun Yat-sen University (SYSU), Guangzhou, China, ³Department of Radiology, Mayo Clinic, Rochester, MN, United States

Keywords: Liver, Elastography, MR elastography; Liver fibrosis; Heterogeneity

Chronic hepatitis B (CHB) viral infection can lead to liver fibrosis. Liver biopsy, the gold standard for liver fibrosis assessment, is invasive and carries risks of complications and sampling errors. MR elastography (MRE) is regarded as the most accurate noninvasive tool for evaluating liver fibrosis. In this study we characterized the spatial heterogeneity of liver stiffness depicted by MRE in patients with CHB and found heterogeneity at all pathological fibrosis stages. The severity of spatial heterogeneity affected the concordance between MRE-based and pathology-based fibrosis staging.

View Presentation Video

Devashish Joshi¹, David Harris², Nikolaos Panagiotopoulos², Danielle Batakis³, Eduardo Grunvald⁴, Xiaofei Zhang⁵, Rashmi Agni⁵, Santiago Horgan⁶, Luke Funk¹, Claude Sirlin³, and Scott Reeder^2,7,8,9,10
1Surgery, University of Wisconsin - Madison, Madison, WI, United States, ²Radiology, University of Wisconsin - Madison, Madison, WI, United States, ³Radiology, Liver Imaging Group, University of California San Diego, La Jolla, CA, United States, ⁴Medicine, University of California San Diego, La Jolla, CA, United States, ⁵Pathology, University of Wisconsin - Madison, Madison, WI, United States, ⁶Surgery, University of California San Diego, La Jolla, CA, United States, ⁷Emergency Medicine, University of Wisconsin - Madison, Madison, WI, United States, ⁸Medicine, University of Wisconsin - Madison, Madison, WI, United States, ⁹Biomedical Engineering, University of Wisconsin - Madison, Madison, WI, United States, ¹⁰Medical Physics, University of Wisconsin - Madison, Madison, WI, United States

Keywords: Liver, Fat

The goal of our study was to correlate quantitative digital microscopic histological markers of hepatic steatosis with MRI-PDFF and demonstrate that microenvironment characterization can be used to evaluate hepatic microstructure in NAFLD for future MRI-based studies. Patients were recruited to undergo weight loss surgery during which a liver biopsy was performed. The biopsies were analyzed for steatosis proportionate area (SPA) and characterization of fat droplets. The SPA strongly correlated to the pathologist grading and MRI-PDFF and the liver fat content strongly correlated with the number of fat droplets. Our work demonstrated the feasibility of using MRI to characterize liver microstructure.

View Presentation Video

Dragana Savic¹, Ferenc E. Mózes¹, Leanne Hodson¹, Stefan Neubauer¹, Michael Pavlides¹, and Ladislav Valkovič^1
1University of Oxford, Oxford, United Kingdom

Keywords: Liver, Liver, L-carnitine, acetylcarnitine

This study investigated serum carnitine species and in-vivo hepatic acetylcarnitine levels as measured with MRS in healthy volunteers, and patients with low-risk NAFLD and high-risk NAFLD. L-carnitine facilitates transport of fatty acids into the mitochondria. We show that a single injection of L-carnitine modulated acetylcarnitine levels in the liver in healthy volunteers and low-risk NAFLD, but that this mechanism was blunted in the high-risk NAFLD group. This was accompanied by changed serum medium-chain and long-chain carnitine species, but only in the high-risk NAFLD group. Further studies are needed to understand the plasma and hepatic metabolic changes of carnitine species.

View Presentation Video

Petr Sedivy¹, Barbora Setinova¹, Martin Burian¹, Dita Pajuelo¹, Milan Hajek¹, Viktor Sebo², Michal Koc², Michaela Siklova², Marina Henikova², Eva Krauzova³, Jan Gojda², Lenka Rossmeislova², Jan Kovar⁴, and Monika Dezortova^1
1MR-Unit, Institute for Clinical and Experimental Medicine, Prague, Czech Republic, ²Department of Pathophysiology, Third Faculty of Medicine, Charles University, University Hospital Královské Vinohrady, Prague, Czech Republic, ³Department of Internal Medicine, Third Faculty of Medicine, Charles University, University Hospital Královské Vinohrady, Prague, Czech Republic, ⁴Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic

Keywords: Liver, Metabolism, fat fraction, liver steatosis, intra- and extramyocellular fat, calf muscle

The effect of a 28-day isocaloric ketogenic diet followed by a 2-day carbohydrate realimentation on adipose tissue and fat content in the liver and calf muscle in 22 obese women was studied using MRS and MRI methods. During the ketogenic diet, there was a significant decrease in liver fat volume (69±20 ml, i.e. decrease 43±4% of basal value) and liver fat content (2.7±0.6 %, i.e. 35±5% of basal value) and reduction cross-section in both subcutaneous (6 %) and visceral (7 %) fat. Contrary, the intramyocellular fat increased during the diet.

View Presentation Video

Anandh Kilpattu Ramaniharan¹, Mary Kate Manhard^1,2, Jean A Tkach^1,2, Andrew T Trout^1,2, Jonathan R Dillman^1,2, and Amol Pednekar^1,2
1Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States, ²Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States

Keywords: Liver, Quantitative Imaging, Relaxometry

Quantitative parametric mapping is an increasingly important tool for non-invasive assessment of liver disease. The extent of change in both water and fat content in the liver is dependent on the type and stage of the disease. Thus, proton density fat fraction (PDFF%) can have a confounding influence on the longitudinal change in estimated hepatic T₁, T₂, and T₂* measurements. In 14 research participants, T₁ was proportionately underestimated (4.70 (2.85, 6.54) ms/PDFF%) and T₂ was proportionately overestimated (-0.60 (-0.76, -0.43) ms/PDFF%) with non-fat-suppressed parametric map compared to analogous estimates with fat-suppressed parametric maps, while T₂* estimates were insensitive to PDFF.

View Presentation Video

Nikolaos Panagiotopoulos^1,2, Nathan T Roberts³, David Harris¹, Daiki Tamada¹, Ty Cashen³, Thekla H Oechtering^1,2, Diego Hernando^1,4,5,6, Claude B Sirlin⁷, and Scott B Reeder^1,4,5,8,9
1Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States, ²Department of Radiology and Nuclear Medicine, Universität zu Lübeck, Lübeck, Germany, ³GE Healthcare, Waukesha, WI, United States, ⁴Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States, ⁵Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States, ⁶Department of Departments of Electrical & Computer Engineering, University of Wisconsin-Madison, Madison, WI, United States, ⁷Department of Radiology, University of California San Diego, San Diego, CA, United States, ⁸Department of Medicine, University of Wisconsin-Madison, Madison, WI, United States, ⁹Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, United States

Keywords: Liver, Quantitative Imaging

Deep learning (DL)-based MR reconstruction methods show promise to reduce image noise compared to conventional image reconstruction while maintaining quantitative accuracy. The purpose of this work is to apply and evaluate the performance of DL reconstruction to chemical shift-encoded MRI for quantification of proton density fat-fraction (PDFF) in the liver. We compared quantitative PDFF results, test-retest repeatability, and standard deviation within regions of interest in nine patients with a wide range of PDFF (1-31%), for different levels of DL denoising. PDFF between reconstructions showed excellent agreement and constant test-retest repeatability. Standard deviation decreased with increasing DL denoising levels.

Xingchen Pan¹, Jiahui Fu¹, Lei Zhang¹, Yueluan Jiang², Ye Sun¹, Xin Shi¹, and Fan Yang^1
1Department of Radiology, First Hospital of Jilin University, changchun, China, ²MR Scientific Marketing, Siemens Healthineers, Beijing, China

Keywords: Liver, Liver, NAFLD; prognosis; fat fraction; abdominal organ

The relationship between the prognosis of non-alcoholic fatty liver disease (NAFLD) treatment and the fat fraction or fat area of other abdominal organs has not been explored. In this study, we measured the proton density fat fraction of four subsegments of the liver, pancreas, renal cortex, thoracic 12 and lumbar 1 vertebral body, and the area of subcutaneous adipose tissue and visceral adipose tissue at the level of lumbar 3, and explored their relationship with the prognosis of NAFLD.

View Presentation Video

Arthur Peter Wunderlich^1,2, Holger Cario³, Michael Götz², Meinrad Beer¹, and Stefan Andreas Schmidt^1
1Diagnostic and Intervnetional Radiology, Ulm University, Medical Center, Ulm, Germany, ²Section for Experimental Radiology, Ulm University, Medical Center, Ulm, Germany, ³Department of Pediatrics and Adolescent Medicine, Ulm University, Medical Center, Ulm, Germany

Keywords: Liver, Hematologic, Iron overload

Purpose: To evaluate the feasibility of using a balanced steady-state free precession sequence (bSSFP) to determine liver iron content (LIC).

Methods: Thirty-five consecutive patients with liver iron overload were examined with bSSFP. Signal intensity ratios between liver parenchyma and paraspinal muscles were correlated with LIC reference values obtained using Ferriscan.

Results: LIC values ranged from 24 to 756 µmol/g. The best SIR-to-LIC correlation was obtained with 3.5 ms repetition time and 17° excitation flip angle.

Conclusion: bSSFP is suitable to determine LIC. Its advantages are high SNR efficiency and the ability to acquire the entire liver in a breath hold.

View Presentation Video

Sarah Brasher¹, Annie Chan¹, Ayaz Khan², Zachary Abramson², Cara Morin³, and Aaryani Tipirneni-Sajja^1,2
1Biomedical Engineering, University of Memphis, Memphis, TN, United States, ²Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, United States, ³Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Keywords: Liver, Phantoms

Size and concentration of iron will affect the dephasing of an MRI signal. However, iron particle size is often unaccounted for in phantom studies investigating iron overload. In this study, phantoms utilizing iron nanoparticles of different diameters were used to mimic in vivo iron deposits, and R2* quantification was analyzed using different signal models. Our results show that R2* was higher and more unstable in phantoms with iron particles of 500nm diameter in comparison to those with 250nm and 130nm particles potentially due to clustering. High iron concentrations and large iron particle sizes were also shown to confound fat quantification.