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CC BY 4.0 · Journal of Gastrointestinal and Abdominal Radiology 2024; 07(03): 215-225
DOI: 10.1055/s-0044-1786812
Regular Articles
Review Article

Magnetic Resonance Elastography of Liver: Current Status and Future Directions

Argha Chatterjee 
1   Department of Radiology, Tata Medical Center, Kolkata, West Bengal, India
,
Frank H. Miller
2   Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
,
Emily Pang
3   Department of Abdominal Imaging, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
› Author Affiliations Funding None.
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Abstract

Chronic liver disease (CLD) has been recently recognized as a major public health priority. Assessment of presence and degree of liver fibrosis is critical to the management of CLD and traditionally required a liver biopsy. However, biopsy has many limitations including the risk of complications and sampling error. Magnetic resonance elastography (MRE) has emerged as a noninvasive and highly accurate technique for evaluating liver fibrosis. In this comprehensive review, we will delve into the current uses and guidelines for the usage of MRE in CLD, highlighting its advantages and limitations.

Keywords

liver fibrosis - metabolic dysfunction-associated steatohepatitis - quantitative imaging


Publication History

Article published online:
16 May 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 GBD 2017 Cirrhosis Collaborators. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol 2020; 5 (03) 245-266
    CrossrefPubMedGoogle Scholar
  • 2 Mondal D, Das K, Chowdhury A. Epidemiology of liver diseases in India. Clin Liver Dis (Hoboken) 2022; 19 (03) 114-117
    CrossrefPubMedGoogle Scholar
  • 3 India State-Level Disease Burden Initiative Collaborators. Nations within a nation: variations in epidemiological transition across the states of India, 1990-2016 in the Global Burden of Disease Study. Lancet 2017; 390 (10111): 2437-2460
    CrossrefPubMedGoogle Scholar
  • 4 Selvaraj EA, Mózes FE, Jayaswal ANA. et al; LITMUS Investigators. Diagnostic accuracy of elastography and magnetic resonance imaging in patients with NAFLD: a systematic review and meta-analysis. J Hepatol 2021; 75 (04) 770-785
    CrossrefPubMedGoogle Scholar
  • 5 Venkatesh SK, Ehman RL. Magnetic resonance elastography of abdomen. Abdom Imaging 2015; 40 (04) 745-759
    CrossrefPubMedGoogle Scholar
  • 6 Manduca A, Oliphant TE, Dresner MA. et al. Magnetic resonance elastography: non-invasive mapping of tissue elasticity. Med Image Anal 2001; 5 (04) 237-254
    CrossrefPubMedGoogle Scholar
  • 7 Bashir M, Horowitz J, Kamel I. et al. American College of Radiology. ACR Appropriateness Criteria Chronic Liver Disease. Accessed on January 28 2024. Available at: https://acsearch.acr.org/docs/3098416/Narrative/
    Google Scholar
  • 8 Horowitz JM, Venkatesh SK, Ehman RL. et al. Evaluation of hepatic fibrosis: a review from the society of abdominal radiology disease focus panel. Abdom Radiol (NY) 2017; 42 (08) 2037-2053
    CrossrefPubMedGoogle Scholar
  • 9 Guglielmo FF, Barr RG, Yokoo T. et al. Liver fibrosis, fat, and iron evaluation with MRI and fibrosis and fat evaluation with US: a practical guide for radiologists. Radiographics 2023; 43 (06) e220181
    CrossrefPubMedGoogle Scholar
  • 10 Yin M, Talwalkar JA, Glaser KJ. et al. Dynamic postprandial hepatic stiffness augmentation assessed with MR elastography in patients with chronic liver disease. AJR Am J Roentgenol 2011; 197 (01) 64-70
    CrossrefPubMedGoogle Scholar
  • 11 Hallinan JTPD, Alsaif HS, Wee A, Venkatesh SK. Magnetic resonance elastography of liver: influence of intravenous gadolinium administration on measured liver stiffness. Abdom Imaging 2015; 40 (04) 783-788
    CrossrefPubMedGoogle Scholar
  • 12 Wang K, Manning P, Szeverenyi N. et al. Repeatability and reproducibility of 2D and 3D hepatic MR elastography with rigid and flexible drivers at end-expiration and end-inspiration in healthy volunteers. Abdom Radiol (NY) 2017; 42 (12) 2843-2854
    CrossrefPubMedGoogle Scholar
  • 13 Wagner M, Besa C, Bou Ayache J. et al. Magnetic resonance elastography of the liver: qualitative and quantitative comparison of gradient echo and spin echo echoplanar imaging sequences. Invest Radiol 2016; 51 (09) 575-581
    CrossrefPubMedGoogle Scholar
  • 14 Wang J, Glaser KJ, Zhang T. et al. Assessment of advanced hepatic MR elastography methods for susceptibility artifact suppression in clinical patients. J Magn Reson Imaging 2018; 47 (04) 976-987
    CrossrefPubMedGoogle Scholar
  • 15 Loomba R, Cui J, Wolfson T. et al. Novel 3D magnetic resonance elastography for the noninvasive diagnosis of advanced fibrosis in NAFLD: a prospective study. Am J Gastroenterol 2016; 111 (07) 986-994
    CrossrefPubMedGoogle Scholar
  • 16 Catania R, Lopes Vendrami C, Bolster BD, Niemzcura R, Borhani AA, Miller FH. Intra-patient comparison of 3D and 2D magnetic resonance elastography techniques for assessment of liver stiffness. Abdom Radiol (NY) 2022; 47 (03) 998-1008
    CrossrefPubMedGoogle Scholar
  • 17 Morisaka H, Motosugi U, Glaser KJ. et al. Comparison of diagnostic accuracies of two- and three-dimensional MR elastography of the liver. J Magn Reson Imaging 2017; 45 (04) 1163-1170
    CrossrefPubMedGoogle Scholar
  • 18 Martinez SM, Foucher J, Combis JM. et al. Longitudinal liver stiffness assessment in patients with chronic hepatitis C undergoing antiviral therapy. PLoS One 2012; 7 (10) e47715
    CrossrefPubMedGoogle Scholar
  • 19 Marcellin P, Gane E, Buti M. et al. Regression of cirrhosis during treatment with tenofovir disoproxil fumarate for chronic hepatitis B: a 5-year open-label follow-up study. Lancet 2013; 381 (9865): 468-475
    CrossrefPubMedGoogle Scholar
  • 20 Regev A, Berho M, Jeffers LJ. et al. Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol 2002; 97 (10) 2614-2618
    CrossrefPubMedGoogle Scholar
  • 21 Baranova A, Lal P, Birerdinc A, Younossi ZM. Non-invasive markers for hepatic fibrosis. BMC Gastroenterol 2011; 11: 91
    CrossrefPubMedGoogle Scholar
  • 22 Srinivasa Babu A, Wells ML, Teytelboym OM. et al. Elastography in chronic liver disease: modalities, techniques, limitations, and future directions. Radiographics 2016; 36 (07) 1987-2006
    CrossrefPubMedGoogle Scholar
  • 23 Rustogi R, Horowitz J, Harmath C. et al. Accuracy of MR elastography and anatomic MR imaging features in the diagnosis of severe hepatic fibrosis and cirrhosis. J Magn Reson Imaging 2012; 35 (06) 1356-1364
    CrossrefPubMedGoogle Scholar
  • 24 Yin M, Talwalkar JA, Glaser KJ. et al. Assessment of hepatic fibrosis with magnetic resonance elastography. Clin Gastroenterol Hepatol 2007; 5 (10) 1207-1213.e2
    CrossrefPubMedGoogle Scholar
  • 25 Batheja M, Vargas H, Silva AM. et al. Magnetic resonance elastography (MRE) in assessing hepatic fibrosis: performance in a cohort of patients with histological data. Abdom Imaging 2015; 40 (04) 760-765
    CrossrefPubMedGoogle Scholar
  • 26 Singh S, Venkatesh SK, Wang Z. et al. Diagnostic performance of magnetic resonance elastography in staging liver fibrosis: a systematic review and meta-analysis of individual participant data. Clin Gastroenterol Hepatol 2015; 13 (03) 440-451.e6
    CrossrefPubMedGoogle Scholar
  • 27 Guglielmo FF, Venkatesh SK, Mitchell DG. Liver MR elastography technique and image interpretation: pearls and pitfalls. Radiographics 2019; 39 (07) 1983-2002
    CrossrefPubMedGoogle Scholar
  • 28 Strader DB, Wright T, Thomas DL, Seeff LB. American Association for the Study of Liver Diseases. Diagnosis, management, and treatment of hepatitis C. Hepatology 2004; 39 (04) 1147-1171
    CrossrefPubMedGoogle Scholar
  • 29 Takamura T, Motosugi U, Ichikawa S. et al. Usefulness of MR elastography for detecting clinical progression of cirrhosis from Child-Pugh class A to B in patients with type C viral hepatitis. J Magn Reson Imaging 2016; 44 (03) 715-722
    CrossrefPubMedGoogle Scholar
  • 30 Younossi ZM, Stepanova M, Younossi Y. et al. Epidemiology of chronic liver diseases in the USA in the past three decades. Gut 2020; 69 (03) 564-568
    CrossrefPubMedGoogle Scholar
  • 31 Bedossa P. Pathology of non-alcoholic fatty liver disease. Liver Int 2017; 37 (Suppl. 01) 85-89
    CrossrefPubMedGoogle Scholar
  • 32 Younossi ZM, Stepanova M, Rafiq N. et al. Nonalcoholic steatofibrosis independently predicts mortality in nonalcoholic fatty liver disease. Hepatol Commun 2017; 1 (05) 421-428
    CrossrefPubMedGoogle Scholar
  • 33 Rinella ME. Nonalcoholic fatty liver disease: a systematic review. JAMA 2015; 313 (22) 2263-2273
    CrossrefPubMedGoogle Scholar
  • 34 Dulai PS, Sirlin CB, Loomba R. MRI and MRE for non-invasive quantitative assessment of hepatic steatosis and fibrosis in NAFLD and NASH: clinical trials to clinical practice. J Hepatol 2016; 65 (05) 1006-1016
    CrossrefPubMedGoogle Scholar
  • 35 Schwimmer JB, Middleton MS, Behling C. et al. Magnetic resonance imaging and liver histology as biomarkers of hepatic steatosis in children with nonalcoholic fatty liver disease. Hepatology 2015; 61 (06) 1887-1895
    CrossrefPubMedGoogle Scholar
  • 36 Chen J, Talwalkar JA, Yin M, Glaser KJ, Sanderson SO, Ehman RL. Early detection of nonalcoholic steatohepatitis in patients with nonalcoholic fatty liver disease by using MR elastography. Radiology 2011; 259 (03) 749-756
    CrossrefPubMedGoogle Scholar
  • 37 Kim D, Kim WR, Talwalkar JA, Kim HJ, Ehman RL. Advanced fibrosis in nonalcoholic fatty liver disease: noninvasive assessment with MR elastography. Radiology 2013; 268 (02) 411-419
    CrossrefPubMedGoogle Scholar
  • 38 Loomba R, Wolfson T, Ang B. et al. Magnetic resonance elastography predicts advanced fibrosis in patients with nonalcoholic fatty liver disease: a prospective study. Hepatology 2014; 60 (06) 1920-1928
    CrossrefPubMedGoogle Scholar
  • 39 Costa-Silva L, Ferolla SM, Lima AS, Vidigal PVT, Ferrari TCA. MR elastography is effective for the non-invasive evaluation of fibrosis and necroinflammatory activity in patients with nonalcoholic fatty liver disease. Eur J Radiol 2018; 98: 82-89
    CrossrefPubMedGoogle Scholar
  • 40 Cui J, Ang B, Haufe W. et al. Comparative diagnostic accuracy of magnetic resonance elastography vs. eight clinical prediction rules for non-invasive diagnosis of advanced fibrosis in biopsy-proven non-alcoholic fatty liver disease: a prospective study. Aliment Pharmacol Ther 2015; 41 (12) 1271-1280
    CrossrefPubMedGoogle Scholar
  • 41 Venkatesh SK, Wells ML, Miller FH. et al. Magnetic resonance elastography: beyond liver fibrosis-a case-based pictorial review. Abdom Radiol (NY) 2018; 43 (07) 1590-1611
    CrossrefPubMedGoogle Scholar
  • 42 Serai SD, Obuchowski NA, Venkatesh SK. et al. Repeatability of MR elastography of liver: a meta-analysis. Radiology 2017; 285 (01) 92-100
    CrossrefPubMedGoogle Scholar
  • 43 Cui J, Philo L, Nguyen P. et al. Sitagliptin vs. placebo for non-alcoholic fatty liver disease: a randomized controlled trial. J Hepatol 2016; 65 (02) 369-376
    CrossrefPubMedGoogle Scholar
  • 44 Jayakumar S, Middleton MS, Lawitz EJ. et al. Longitudinal correlations between MRE, MRI-PDFF, and liver histology in patients with non-alcoholic steatohepatitis: analysis of data from a phase II trial of selonsertib. J Hepatol 2019; 70 (01) 133-141
    CrossrefPubMedGoogle Scholar
  • 45 Venkatesh SK, Yin M, Glockner JF. et al. MR elastography of liver tumors: preliminary results. AJR Am J Roentgenol 2008; 190 (06) 1534-1540
    CrossrefPubMedGoogle Scholar
  • 46 Motosugi U, Ichikawa T, Koshiishi T. et al. Liver stiffness measured by magnetic resonance elastography as a risk factor for hepatocellular carcinoma: a preliminary case-control study. Eur Radiol 2013; 23 (01) 156-162
    CrossrefPubMedGoogle Scholar
  • 47 Cho HJ, Kim B, Kim HJ. et al. Liver stiffness measured by MR elastography is a predictor of early HCC recurrence after treatment. Eur Radiol 2020; 30 (08) 4182-4192
    CrossrefPubMedGoogle Scholar
  • 48 Talwalkar JA, Yin M, Venkatesh S. et al. Feasibility of in vivo MR elastographic splenic stiffness measurements in the assessment of portal hypertension. AJR Am J Roentgenol 2009; 193 (01) 122-127
    CrossrefPubMedGoogle Scholar
  • 49 Morisaka H, Motosugi U, Ichikawa S, Sano K, Ichikawa T, Enomoto N. Association of splenic MR elastographic findings with gastroesophageal varices in patients with chronic liver disease. J Magn Reson Imaging 2015; 41 (01) 117-124
    CrossrefPubMedGoogle Scholar
  • 50 Egbe A, Miranda WR, Connolly HM. et al. Temporal changes in liver stiffness after Fontan operation: results of serial magnetic resonance elastography. Int J Cardiol 2018; 258: 299-304
    CrossrefPubMedGoogle Scholar
  • 51 Navin PJ, Gidener T, Allen AM. et al. The role of magnetic resonance elastography in the diagnosis of noncirrhotic portal hypertension. Clin Gastroenterol Hepatol 2020; 18 (13) 3051-3053.e2
    CrossrefPubMedGoogle Scholar
  • 52 Asrani SK, Talwalkar JA, Kamath PS. et al. Role of magnetic resonance elastography in compensated and decompensated liver disease. J Hepatol 2014; 60 (05) 934-939
    CrossrefPubMedGoogle Scholar
  • 53 Bashir MR, Horowitz JM, Kamel IR. et al; Expert Panel on Gastrointestinal Imaging. ACR Appropriateness Criteria® chronic liver disease. J Am Coll Radiol 2020; 17 (5S): S70-S80
    CrossrefPubMedGoogle Scholar
  • 54 Chen J, Yin M, Talwalkar JA. et al. Diagnostic performance of MR elastography and vibration-controlled transient elastography in the detection of hepatic fibrosis in patients with severe to morbid obesity. Radiology 2017; 283 (02) 418-428
    CrossrefPubMedGoogle Scholar
  • 55 Guo Y, Parthasarathy S, Goyal P, McCarthy RJ, Larson AC, Miller FH. Magnetic resonance elastography and acoustic radiation force impulse for staging hepatic fibrosis: a meta-analysis. Abdom Imaging 2015; 40 (04) 818-834
    CrossrefPubMedGoogle Scholar
  • 56 Singh S, Venkatesh SK, Loomba R. et al. Magnetic resonance elastography for staging liver fibrosis in non-alcoholic fatty liver disease: a diagnostic accuracy systematic review and individual participant data pooled analysis. Eur Radiol 2016; 26 (05) 1431-1440
    CrossrefPubMedGoogle Scholar
  • 57 Chou C-T, Chen R-C, Wu W-P, Lin P-Y, Chen Y-L. Prospective comparison of the diagnostic performance of magnetic resonance elastography with acoustic radiation force impulse elastography for pre-operative staging of hepatic fibrosis in patients with hepatocellular carcinoma. Ultrasound Med Biol 2017; 43 (12) 2783-2790
    CrossrefPubMedGoogle Scholar
  • 58 Yin M, Venkatesh SK. Ultrasound or MR elastography of liver: which one shall I use?. Abdom Radiol (NY) 2018; 43 (07) 1546-1551
    CrossrefPubMedGoogle Scholar
  • 59 Trout AT, Sheridan RM, Serai SD. et al. Diagnostic performance of MR elastography for liver fibrosis in children and young adults with a spectrum of liver diseases. Radiology 2018; 287 (03) 824-832
    CrossrefPubMedGoogle Scholar
  • 60 El-Meteini M, Sakr M, Eldorry A. et al. Non-invasive assessment of graft fibrosis after living donor liver transplantation: is there still a role for liver biopsy?. Transplant Proc 2019; 51 (07) 2451-2456
    CrossrefPubMedGoogle Scholar
  • 61 Perumpail RB, Levitsky J, Wang Y. et al. MRI-guided biopsy to correlate tissue specimens with MR elastography stiffness readings in liver transplants. Acad Radiol 2012; 19 (09) 1121-1126
    CrossrefPubMedGoogle Scholar
  • 62 Lee VS, Miller FH, Omary RA. et al. Magnetic resonance elastography and biomarkers to assess fibrosis from recurrent hepatitis C in liver transplant recipients. Transplantation 2011; 92 (05) 581-586
    CrossrefPubMedGoogle Scholar
  • 63 Navin PJ, Olson MC, Knudsen JM, Venkatesh SK. Elastography in the evaluation of liver allograft. Abdom Radiol (NY) 2021; 46 (01) 96-110
    CrossrefPubMedGoogle Scholar
  • 64 Sugimoto M, Oka H, Kajihama A. et al. Non-invasive assessment of liver fibrosis by magnetic resonance elastography in patients with congenital heart disease undergoing the Fontan procedure and intracardiac repair. J Cardiol 2016; 68 (03) 202-208
    CrossrefPubMedGoogle Scholar
  • 65 Idilman IS, Li J, Yin M, Venkatesh SK. MR elastography of liver: current status and future perspectives. Abdom Radiol (NY) 2020; 45 (11) 3444-3462
    CrossrefPubMedGoogle Scholar
  • 66 Shi Y, Guo Q, Xia F. et al. MR elastography for the assessment of hepatic fibrosis in patients with chronic hepatitis B infection: does histologic necroinflammation influence the measurement of hepatic stiffness?. Radiology 2014; 273 (01) 88-98
    CrossrefPubMedGoogle Scholar
  • 67 Ichikawa S, Motosugi U, Nakazawa T. et al. Hepatitis activity should be considered a confounder of liver stiffness measured with MR elastography. J Magn Reson Imaging 2015; 41 (05) 1203-1208
    CrossrefPubMedGoogle Scholar
  • 68 Kim DK, Choi JY, Park M-S, Kim M-J, Chung YE. Clinical feasibility of MR elastography in patients with biliary obstruction. AJR Am J Roentgenol 2018; 210 (06) 1273-1278
    CrossrefPubMedGoogle Scholar
  • 69 Fenstad ER, Dzyubak B, Oh JK. et al. Evaluation of liver stiffness with magnetic resonance elastography in patients with constrictive pericarditis: preliminary findings. J Magn Reson Imaging 2016; 44 (01) 81-88
    CrossrefPubMedGoogle Scholar
  • 70 Ghoz HM, Kröner PT, Stancampiano FF. et al. Hepatic iron overload identified by magnetic resonance imaging-based T2* is a predictor of non-diagnostic elastography. Quant Imaging Med Surg 2019; 9 (06) 921-927
    CrossrefPubMedGoogle Scholar
  • 71 Kim DW, Kim SY, Yoon HM, Kim KW, Byun JH. Comparison of technical failure of MR elastography for measuring liver stiffness between gradient-recalled echo and spin-echo echo-planar imaging: a systematic review and meta-analysis. J Magn Reson Imaging 2020; 51 (04) 1086-1102
    CrossrefPubMedGoogle Scholar