Multiparametric MR mapping in clinical decision-making for diffuse liver disease
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SPECIAL SECTION: DIFFUSE LIVER DISEASE
Multiparametric MR mapping in clinical decision‑making for diffuse liver disease Helena B. Thomaides‑Brears1 · Rita Lepe2 · Rajarshi Banerjee1 · Carlos Duncker3 Received: 27 March 2020 / Revised: 12 June 2020 / Accepted: 22 July 2020 © The Author(s) 2020
Abstract Accurate diagnosis, monitoring and treatment decisions in patients with chronic liver disease currently rely on biopsy as the diagnostic gold standard, and this has constrained early detection and management of diseases that are both varied and can be concurrent. Recent developments in multiparametric magnetic resonance imaging (mpMRI) suggest real potential to bridge the diagnostic gap between non-specific blood-based biomarkers and invasive and variable histological diagnosis. This has implications for the clinical care and treatment pathway in a number of chronic liver diseases, such as haemochromatosis, steatohepatitis and autoimmune or viral hepatitis. Here we review the relevant MRI techniques in clinical use and their limitations and describe recent potential applications in various liver diseases. We exemplify case studies that highlight how these techniques can improve clinical practice. These techniques could allow clinicians to increase their arsenals available to utilise on patients and direct appropriate treatments. Keywords Multiparametric magnetic resonance imaging · cT1 · Elastography · Diffusion-weighted imaging · T2* · PDFF
Introduction Chronic liver disease leads to progressive injury from various aetiologies such as: iron overload, steatosis, steatohepatitis, viral hepatitis, autoimmune, metabolic disease and some drug toxicities. These represent the majority of aetiologies of liver diseases and vary in estimated worldwide prevalence so that of 112 million prevalent cases of compensated cirrhosis reported in 2017, 36 million were due to hepatitis B, 23 million from alcoholic liver disease and 4 million from non-alcoholic steatohepatitis [1]. In recent clinical practice, the number of referrals for abdominal and liver magnetic resonance (MR), including focussed liver MRI for diffuse disease, has increased. In part this is because tools used in current clinical practice for the diagnosis of liver disease have intrinsic limitations. * Helena B. Thomaides‑Brears Helena.Thomaides‑[email protected] 1
Perspectum, Gemini One, 5520 John Smith Drive, Oxford OX4 2LL, UK
2
Texas Liver Institute, 607 Camden St, Suite 101, San Antonio, TX 78215, USA
3
Perspectum, 600 N. Pearl St. Suite 1960, Plaza of The Americas, Dallas, TX 75201, USA
Screening, monitoring and therapy decision-making abilities of multi-parametric MRI (mpMRI) are being increasingly recognised by hepatologists and gastroenterologists. Liver biopsy on the other hand is invasive, associated with potential complications [2–4] and subject to variability in sampling and interpretation [5–7]. Serum biomarkers are widely available but are non-specific [8–11]. Transient elastography (TE) and controlled attenuation parameter (C
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