Feasibility of Spin-Echo Echo-Planar Imaging MR Elastography in Livers of Children and Young Adults

Jin Kyem Kim; Haesung Yoon; Mi-Jung Lee; Myung-Joon Kim; Kyunghwa Han; Hong Koh; Kyunghwa Han; Hong Koh; Seung Kim; Seok Joo Han; Hyun Joo Shin

doi:10.13104/imri.2019.23.3.251

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

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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

Original Article

iMRI 2019;23(3):251-258.

Published online: 12 January 2019

DOI: https://doi.org/10.13104/imri.2019.23.3.251

Feasibility of Spin-Echo Echo-Planar Imaging MR Elastography in Livers of Children and Young Adults

Jin Kyem Kim, Haesung Yoon, Mi-Jung Lee, Myung-Joon Kim, Kyunghwa Han, Hong Koh, Kyunghwa Han, Hong Koh, Seung Kim, Seok Joo Han, Hyun Joo Shin

^¹Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea

^²Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea

^³Department of Pediatric Gastroenterology, Hepatology and Nutrition, Yonsei University College of Medicine, Seoul, Korea

^⁴Department of Pediatric Surgery, Yonsei University College of Medicine, Seoul, Korea

^⁵Severance Pediatric Liver Disease Research Group, Yonsei University College of Medicine, Seoul, Korea

Correspondence to: Hyun Joo Shin, M.D., Ph.D. Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Tel. +82-2-2228-7400 Fax. +82-2-2227-8337 E-mail: lamer-22@yuhs.ac

Received 11 June 2019 Revised 27 June 2019 Accepted 9 July 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Child, Young adult, Liver, Magnetic resonance imaging, Elasticity imaging techniques

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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.

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%.

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.

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
Image quality scores (n)	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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