Journal List > Investig Magn Reson Imaging > v.23(3) > 1135554

Kim, Yoon, Lee, Kim, Han, Koh, Han, Koh, Kim, Han, and Shin: Feasibility of Spin-Echo Echo-Planar Imaging MR Elastography in Livers of Children and Young Adults

Abstract

Purpose

To assess the feasibility of the use of spin-echo echo-planar imaging (SE-EPI) magnetic resonance elastography (MRE) in livers of children and young adults.

Materials and Methods

Patients (≤ 20 years old) who underwent 3T SE-EPI MRE were included retrospectively. Subjects were divided into three groups according to the purpose of the liver MRI: suspicion of fatty liver or focal fat deposition in the liver (FAT group), liver fibrosis after receiving a Kasai operation from biliary atresia (BA group), and hepatic iron deposition after receiving chemotherapy or transfusions (IRON group). Technical failure of MRE was defined when a stiffness map showed no pixel value with a confidence index higher than 95%, and the patients were divided as success and failure groups accordingly. Clinical findings including age, gender, weight, height, and body mass index and magnetic resonance imaging results including proton density fat fraction (PDFF), T2*, and MRE values were assessed. Factors affecting failure of MRE were evaluated and the image quality in wave propagation image and stiffness map was evaluated using the appropriate scores.

Results

Among total 240 patients (median 15 years, 211 patients in the FAT, 21 patients in the BA, and 8 patients in the IRON groups), technical failure was noted in six patients in the IRON group (6/8 patients, 75%), while there were no failures noted in the FAT and BA groups. These six patients had T2* values ranging from 0.9 to 3.8 ms. The image quality scores were not significantly different between the FAT and BA groups (P > 0.999), while the scores were significantly lower in the IRON group (P < 0.001).

Conclusion

The 3T SE-EPI MRE in children and young adults had a high technical success rate. The technical failure was occurred in children with decreased T2* value (≤ 3.8 ms) from iron deposition.

References

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Fig. 1.
Technical success of SE-EPI MRE in a 16-year-old female who had multiple chemotherapies for paranasal rhabdomyosarcoma 5 years ago. (a) T2* value in the liver was 4 ms, suggesting iron deposition in the liver. (b) As in the color map, there was available area for measuring liver stiffness and the MRE value in the liver was 2.4 kPa.
imri-23-251f1.tif
Fig. 2.
Technical failure of SE-EPI MRE in a 20-year-old female who had multiple transfusions for aplastic anemia. (a) T2* value in the liver was 3.8 ms, suggesting iron deposition in the liver. (b) As in the color map, there was no area appropriate for measuring stiffness in the liver because there was no pixel value with a confidence index higher than 95%.
imri-23-251f2.tif
Fig. 3.
T2* values in all 240 patients. A total of 2.5% of patients who had T2* values ≤ 3.8 ms had technical failure of SE-EPI MRE.
imri-23-251f3.tif
Table 1.
Comparison of Clinical and MRI Results in FAT, BA, and IRON Groups
Groups FAT (n = 211) BA (n = 21) IRON (n = 8) P-value1 (All) P-value2 (FAT vs. BA) P-value3 (FAT vs. IRON) P-value4 (BA vs. IRON)
Age (years) 14 (11–16) 9 (8–11) 17 (13–18) < 0.001 < 0.001 0.167 0.008
Gender (M:F) 159:52 9:12 3:5 0.002 0.003 0.030 0.568
Weight (kg) 67 (49–83) 33 (26–44) 57 (44–63) < 0.001 < 0.001 0.126 0.025
Height (cm) 159 (148–172) 137 (127–149) 163 (156–164) < 0.001 < 0.001 0.695 0.008
BMI (kg/m2) 26.4 (22.2–29.4) 17.6 (15.4–18.5) 21.5 (18.4–23.5) < 0.001 < 0.001 0.005 0.051
PDFF (%) 18 (7–31.1) 2.2 (1.7–4) 4.1 (2.6–5.5) < 0.001 < 0.001 0.002 0.143
T2* (ms) 20 (17–24) 23 (18.5–25.5) 2.6 (2.0–4.0) < 0.001 0.056 < 0.001 < 0.001
MRE (kPa) 2.4 (2–2.8) 3.3 (3.1–4.9) 2.1 (1.8-.) < 0.001 < 0.001 0.332 0.022

Values are presented in median values with interquartile ranges, P values are obtained from a Kruskal-Wallis test or Fisher's exact test, after testing with Dunn's method for multiple comparisons. BA = liver fibrosis after receiving a Kasai operation from biliary atresia; BMI = body mass index; FAT = suspicion of fatty liver or focal fat deposition in the liver; IRON = hepatic iron deposition after receiving chemotherapy or multiple transfusions; MRE = magnetic resonance elastography; PDFF = MR proton density fat fraction

Table 2.
Comparison of Technical Failure and Image Quality of SE-EPI MRE in FAT, BA, and IRON Groups
Groups FAT (n = 211) BA (n = 21) IRON (n = 8) P-value1 (All) P-value2 (FAT vs. BA) P-value3 (FAT vs. IRON) P-value4 (BA vs. IRON)
Failure (n) 0 0 6 (75%) < 0.001 > 0.999 < 0.001 < 0.001
Image quality scores (n) Wave propagation image (0/1/2) 0/75/136 0/8/13 6/2/0 < 0.001 > 0.999 < 0.001 < 0.001
Stiffness map (0/1/2) 0/0/211 0/0/21 6/0/2 < 0.001 > 0.999 < 0.001 < 0.001

P values are obtained from a Kruskal-Wallis test after testing with Dunn's method for multiple comparisons. BA = liver fibrosis after receiving a Kasai operation from biliary atresia; FAT = suspicion of fatty liver or focal fat deposition in the liver; IRON = hepatic iron deposition after receiving chemotherapy or multiple transfusions; MRE = magnetic resonance elastography

Table 3.
Comparison of Clinical and MRI Results in FAT, BA, and IRON Groups According to the Image Quality Scores in Wave Propagation Map
  FAT group   P-value BA group P-value IRON group P-value
Scores in wave propagation map 1 (n = 75) 2 (n = 136)   1 (n = 8) 2 (n = 13)   0 (n = 6) 1 (n = 2)  
Age 13 (10–16) 14.5 (12–17) 0.024 10 (9–13.8) 9 (7.5–11.0) 0.185 17 (14.3–18.5) 10.5 (5.0-) 0.180
BMI 2 26.5 (23.6–29.7) ) 26 (21.5–29.4 4) 0.171 18.3 (17.8–22.3) 15.7 (15.2–18.0 ) 0.012 22.1 (19.7–23.8) 17.6 (13.3-) 0.317
PDFF 25 (13–38) 14.6 (4.4–26.0) ) < 0.001 3.7 (2.7–5.0) 1.9 (1.6–2.6) 0.035 4.1 (1.8–5.3) 4.3 (3.0-) 0.558
T2* 18 (16–22) 21 (18–25) < 0.001 21 (18–23.8) 24 (20–27) 0.136 2.3 (1.7–2.9) 4.5 (4.0-) 0.046
MRE 2.4 (2.0–2.8) 2.4 (2.0–2.8) 0.964 3.2 (2.8–4.0) 3.5 (3.2–5.9) 0.345 NA 2.1 (1.8-) NA

Values are presented in median values with interquartile ranges, P values are obtained from a Mann-Whitney U test. BA = liver fibrosis after receiving a Kasai operation from biliary atresia; BMI = body mass index; FAT = suspicion of fatty liver or focal fat deposition in the liver; MRE = magnetic resonance elastography; NA = not applicable; PDFF = MR proton density fat fraction

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