Quantitative liver MRI combining phase contrast imaging, elastography, and DWI: assessment of reproducibility and postprandial effect at 3.0 T

Guido H Jajamovich, Hadrien Dyvorne, Claudia Donnerhack, Bachir Taouli, Guido H Jajamovich, Hadrien Dyvorne, Claudia Donnerhack, Bachir Taouli

Abstract

Purpose: To quantify short-term reproducibility (in fasting conditions) and postprandial changes after a meal in portal vein (PV) flow parameters measured with phase contrast (PC) imaging, liver diffusion parameters measured with multiple b value diffusion-weighted imaging (DWI) and liver stiffness (LS) measured with MR elastography (MRE) in healthy volunteers and patients with liver disease at 3.0 T.

Materials and methods: In this IRB-approved prospective study, 30 subjects (11 healthy volunteers and 19 liver disease patients; 23 males, 7 females; mean age 46.5 y) were enrolled. Imaging included 2D PC imaging, multiple b value DWI and MRE. Subjects were initially scanned twice in fasting state to assess short-term parameter reproducibility, and then scanned 20 min. after a liquid meal. PV flow/velocity, LS, liver true diffusion coefficient (D), pseudodiffusion coefficient (D*), perfusion fraction (PF) and apparent diffusion coefficient (ADC) were measured in fasting and postprandial conditions. Short-term reproducibility was assessed in fasting conditions by measuring coefficients of variation (CV) and Bland-Altman limits of agreement. Differences in MR metrics before and after caloric intake and between healthy volunteers and liver disease patients were assessed.

Results: PV flow parameters, D, ADC and LS showed good to excellent short-term reproducibility in fasting state (CV <16%), while PF and D* showed acceptable and poor reproducibility (CV = 20.4% and 51.6%, respectively). PV flow parameters and LS were significantly higher (p<0.04) in postprandial state while liver diffusion parameters showed no significant change (p>0.2). LS was significantly higher in liver disease patients compared to healthy volunteers both in fasting and postprandial conditions (p<0.001). Changes in LS were significantly correlated with changes in PV flow (Spearman rho = 0.48, p = 0.013).

Conclusions: Caloric intake had no/minimal/large impact on diffusion/stiffness/portal vein flow, respectively. PC MRI and MRE but not DWI should be performed in controlled fasting state.

Conflict of interest statement

Competing Interests: GE Healthcare provided funding toward this study. There are no patents, products in development, or marketed products to declare. This does not alter our adherence to all PLOS ONE policies on sharing data and materials.

Figures

Figure 1. Study design.
Figure 1. Study design.
All subjects were scanned twice after 6 hours of fasting to assess short-term reproducibility of MRI metrics (subjects were removed from the MRI system and re-imaged). Subjects were then scanned again in postprandial conditions, 20 min. after a 700 kcal liquid meal.
Figure 2. Image processing demonstrated in a…
Figure 2. Image processing demonstrated in a 30 year-old healthy volunteer.
Top row demonstrates the region of interest placement in the portal vein (PV) on the phase contrast magnitude and phase images obtained in fasting and postprandial conditions. PV flow and velocity values were 21.15 ml/s/2.7 cm/s (fasting) and 31.1 ml/s/17.8 cm/s (postprandial). Middle row demonstrates the region of interest placement in the right hepatic lobe on the diffusion images (for b = 15) and plots for bi-exponential fitting in fasting (true diffusion coefficient D, pseudodiffusion coefficient D* and perfusion fraction PF of 1.3×10−3 mm2/s, 57×10−3 mm2/s and 22%) and postprandial conditions (1.1×10−3 mm2/s, 171×10−3 mm2/s, 19%). Bottom row shows the gradient echo MRE reference image (left) and liver stiffness (LS) maps in fasting and postprandial conditions (LS was 1.9 and 1.9 kPa in fasting and postprandial conditions, respectively).
Figure 3. Changes in portal vein (PV)…
Figure 3. Changes in portal vein (PV) flow (A), PV velocity (B), liver stiffness LS measured with MRE (C), liver true diffusion coefficient D (D), pseudodiffusion coefficient D* (E), perfusion fraction PF (F), and apparent diffusion coefficient ADC (G) in fasting (1st exam) and postprandial conditions in 11 healthy volunteers (solid black lines) and 19 patients (dashed red lines).
LS shows a clear separation between healthy volunteers and patients. PV: portal vein, PV flow (ml/s), PV velocity (cm/s), LS (liver stiffness, kPa), D (true diffusion coefficient, ×10−3 mm2/s), D* (pseudodiffusion coefficient, ×10−3 mm2/s), PF (perfusion fraction, %), ADC (apparent diffusion coefficient, ×10−3 mm2/s). *LS was calculated for 27 subjects.
Figure 4. Changes in liver stiffness after…
Figure 4. Changes in liver stiffness after a liquid meal (ΔLS*) correlated to changes in portal vein flow (ΔPV Flow*) in healthy volunteers (blue diamonds) and patients (red squares).
There was a significant correlation between ΔLS vs. ΔPV Flow (Spearman rho = 0.48, p = 0.013 for all subjects; rho = 0.51 p = 0.05 for fibrosis patients, and rho = 0.41, p = 0.21 for healthy volunteers). *Δ computed as 100*(postprandial-fasting)/fasting.

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