Investig Magn Reson Imaging.  2019 Sep;23(3):251-258. 10.13104/imri.2019.23.3.251.

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

• Kim JK
• Yoon H
• Lee MJ
• Kim MJ
• Han K
• Koh H
• Kim S
• Han SJ
• Shin HJ

• KMID: 2459879
• DOI: http://doi.org/10.13104/imri.2019.23.3.251

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.

Keyword

Child; Young adult; Liver; Magnetic resonance imaging; Elasticity imaging techniques

MeSH Terms

Biliary Atresia
Body Mass Index
Child*
Drug Therapy
Echo-Planar Imaging*
Elasticity Imaging Techniques*
Fatty Liver
Humans
Iron
Liver Cirrhosis
Liver*
Magnetic Resonance Imaging
Protons
Retrospective Studies
Young Adult*
Iron
Protons

Figure

• 

  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.

Reference

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