For patients with diffuse liver disease and suspicion of fibrosis, MRI can noninvasively grade the degree of fibrosis as well as detect hepatocellular carcinoma. Fibrosis can be assessed through a noninvasive method referred to as MR elastography. This method uses MRI to measure displacement of liver tissue that is caused by low intensity sound waves. The resulting measurements are processed to generate a map of the stiffness of the liver. An advantage of this method over a liver biopsy is that the map provides information of the degree of fibrosis over a large region of the liver, whereas a biopsy only provides information about a very small sample of the liver.

The maps of stiffness may be interpreted as follows:

Stiffness (kiloPascals) Interpretation
1.6 - 2.92 No fibrosis
2.93 - 4.88 Stage F0 or F1 fibrosis
4.89 - 7 Stage F2 or F3 fibrosis
more than 7 Stage F4

Once fibrosis evaluation is complete, contrast is administered to detect lesions that are suspicious for hepatocellular carcinoma.

Sample Epic Order (click image to enlarge)

References

 
1. Yin, M. et al. Assessment of hepatic fibrosis with magnetic resonance elastography. Clin Gastroenterol Hepatol 5, 1207-1213 e2 (2007).
2. Wang, Q.-B., Zhu, H., Liu, H.-L. & Zhang, B. Performance of magnetic resonance elastography and diffusion-weighted imaging for the staging of hepatic fibrosis: A meta-analysis. Hepatology 56, 239-247 (2012).
3. Rustogi, R. et al. Accuracy of MR elastography and anatomic MR imaging features in the diagnosis of severe hepatic fibrosis and cirrhosis. J Magn Reson Imaging 35, 1356-1364 (2012).
4. Huwart, L. et al. Magnetic resonance elastography for the noninvasive staging of liver fibrosis. Gastroenterology 135, 32-40 (2008).
5. Hines, C. D., Bley, T. A., Lindstrom, M. J. & Reeder, S. B. Repeatability of magnetic resonance elastography for quantification of hepatic stiffness. J Magn Reson Imaging 31, 725-731 (2010).

Last modified Wed, 19 Sep, 2012 at 21:42