MR elastography of liver: current status and future perspectives
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SPECIAL SECTION: DIFFUSE LIVER DISEASE
MR elastography of liver: current status and future perspectives Ilkay S. Idilman1,2 · Jiahui Li1 · Meng Yin1 · Sudhakar K. Venkatesh1 Received: 18 April 2020 / Revised: 6 July 2020 / Accepted: 9 July 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Non-invasive evaluation of liver fibrosis has evolved over the last couple of decades. Currently, elastography techniques are the most widely used non-invasive methods for clinical evaluation of chronic liver disease (CLD). MR elastography (MRE) of the liver has been used in the clinical practice for nearly a decade and continues to be widely accepted for detection and staging of liver fibrosis. With MRE, one can directly visualize propagating shear waves through the liver and an inversion algorithm in the scanner automatically converts the shear wave properties into an elastogram (stiffness map) on which liver stiffness can be calculated. The commonly used MRE method, two-dimensional gradient recalled echo (2D-GRE) sequence has produced excellent results in the evaluation of liver fibrosis in CLD from various etiologies and newer clinical indications continue to emerge. Advances in MRE technique, including 3D MRE, automated liver elasticity calculation, improvements in shear wave delivery and patient experience, are promising to provide a faster and more reliable MRE of liver. Innovations, including evaluation of mechanical parameters, such as loss modulus, displacement, and volumetric strain, are promising for comprehensive evaluation of CLD as well as understanding pathophysiology, and in differentiating various etiologies of CLD. In this review, the current status of the MRE of liver in CLD are outlined and followed by a brief description of advanced techniques and innovations in MRE of liver. Keywords Liver fibrosis · Elasticity · Viscosity · Damping ratio · Volumetric strain · 3D MRE
Introduction Chronic liver injury by any etiology results in inflammation and destruction of hepatocytes, and the liver parenchyma responds by regeneration and fibrosis [1, 2]. Untreated and continued injury leads to increased fibrosis, and when regenerative capacity fails, fibrotic response overwhelms parenchymal regeneration, leading to cirrhosis and its associated complications. Liver fibrosis is the single most important factor that determines the outcome in chronic liver disease (CLD). Early treatment of liver fibrosis is associated with better outcomes, emphasizing the importance of early detection and assessment of severity of liver fibrosis [3–5]. The diagnosis of liver fibrosis can be established directly with histological evaluation from an invasive liver biopsy or * Sudhakar K. Venkatesh [email protected] 1
Department of Radiology, Mayo Clinic Alix College of Medicine, Mayo Clinic, Rochester, MN, USA
Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
2
indirectly by measuring surrogate markers for liver fibrosis. Although liver biopsy is con
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