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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (31 May 2023) | Viewed by 9537

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Prof. Dr. Niklas Verloh

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Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
Interests: diagnostic radiology; interventional radiology; magnetic resonance imaging; computed tomography; contrast agents; artificial intelligence; hepatobiliary imaging; hepatocellular carcinoma; defuse liver disease; minimal invasive therapy
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Dear Colleagues,

The increase in hepatitis and chronic liver diseases is a growing problem for the Western hemisphere, as patients’ morbidity and mortality directly correlate with the progression of hepatic fibrosis. Various imaging modalities, including computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography (US), are being used to evaluate the liver parenchyma in cases of hepatitis. This Special Issue highlights the imaging of inflammation and fibrosis of the liver parenchyma and their associated diseases. Hepatic inflammation initiates fibrogenesis and maintains itself by promoting proinflammatory signaling molecule release and can occur at any stage of liver fibrosis/cirrhosis. However, the distinction between physiology and pathology is blurry as the right degree of inflammation and repair can heal a wound and restore tissue integrity and function, whereas excessive, uncontrolled inflammation or repair mechanisms may lead to tissue dysfunction. Imaging has the potential to visualize these processes and their resulting pathophysiologies on a regional basis. This Special Issue encourages artificial intelligence and innovative imaging techniques to supplement the evaluation.

Dr. Niklas Verloh
Guest Editor

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Keywords

liver imaging
liver fibrosis
liver cirrhoses
hepatic metabolism
functional imaging

Published Papers (7 papers)

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Research

13 pages, 1540 KiB

Open AccessArticle

Volume-Assisted Estimation of Remnant Liver Function Based on Gd-EOB-DTPA Enhanced MR Relaxometry: A Prospective Observational Trial

by Niklas Verloh, Carolina Rio Bartulos, Kirsten Utpatel, Frank Brennfleck, Andrea Goetz, Andreas Schicho, Claudia Fellner, Dominik Nickel, Florian Zeman, Johannes F. Steinmann, Wibke Uller, Christian Stroszczynski, Hans-Jürgen Schlitt, Phillip Wiggermann and Michael Haimerl

Diagnostics 2023, 13(18), 3014; https://doi.org/10.3390/diagnostics13183014 - 21 Sep 2023

Viewed by 775

Abstract

In the context of liver surgery, predicting postoperative liver dysfunction is essential. This study explored the potential of preoperative liver function assessment by MRI for predicting postoperative liver dysfunction and compared these results with the established indocyanine green (ICG) clearance test. This prospective study included patients undergoing liver resection with preoperative MRI planning. Liver function was quantified using T1 relaxometry and correlated with established liver function scores. The analysis revealed an improved model for predicting postoperative liver dysfunction, exhibiting an accuracy (ACC) of 0.79, surpassing the 0.70 of the preoperative ICG test, alongside a higher area under the curve (0.75). Notably, the proposed model also successfully predicted all cases of liver failure and showed potential in predicting liver synthesis dysfunction (ACC 0.78). This model showed promise in patient survival rates with a Hazard ratio of 0.87, underscoring its potential as a valuable tool for preoperative evaluation. The findings imply that MRI-based assessment of liver function can provide significant benefits in the early identification and management of patients at risk for postoperative liver dysfunction. Full article

(This article belongs to the Special Issue Imaging of Hepatitis)

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8 pages, 430 KiB

Open AccessArticle

Diagnostic Accuracy of Indocyanine Green Clearance Test for Different Stages of Liver Fibrosis and Cirrhosis

by Lukas Luerken, Marco Dollinger, Andrea Goetz, Kirstin Utpatel, Michael Christian Doppler, Jakob Benedikt Weiss, Wibke Uller, André Ignee, Niklas Verloh and Michael Haimerl

Diagnostics 2023, 13(16), 2663; https://doi.org/10.3390/diagnostics13162663 - 12 Aug 2023

Cited by 1 | Viewed by 945

Abstract

(1) Background: This study aimed to correlate the indocyanine green clearance (ICG) test with histopathological grades of liver fibrosis and liver cirrhosis to assess its diagnostic accuracy in differentiating normal liver parenchyma from liver fibrosis and liver cirrhosis. (2) Methods: A total of 82 patients who received a histopathological liver examination, imaging, and ICG test within three months were included in this retrospective study. The histopathological level of fibrosis was graded using the Ishak scoring system, and the patients were divided into five categories: no liver fibrosis (NLF), mild liver fibrosis (MLF), advanced liver fibrosis (ALF), severe liver fibrosis (SLF), and liver cirrhosis (LC). The non-parametric Kruskal–Wallis test with post hoc pairwise comparison utilizing Mann–Whitney U tests and Bonferroni adjustment was used to analyze differences in the ICG test results between the patient groups. Cross correlation between the individual fibrosis/cirrhosis stages and the score of the ICG test was performed, and the sensitivity, specificity, and positive and negative predictive values were calculated for each model predicting liver fibrosis/cirrhosis. (3) Results: A significant difference (p ≤ 0.001) between stages of NLF, LF, and LC was found for the ICG parameters (ICG plasma disappearance rate (ICG-PDR) and ICG retention percentage at 15 min (ICG-R15)). The post hoc analysis revealed that NLF significantly differed from SLF (ICG-PDR: p = 0.001; ICG-R15: p = 0.001) and LC (ICG-PDR: p = 0.001; ICG-R15: p = 0.001). ALF also significantly differed from SLF (ICG-PDR: p = 0.033; ICG-R15: p = 0.034) and LC (ICG-PDR: p = 0.014; ICG-R15: p = 0.014). The sensitivity for detection of an initial stage of liver fibrosis compared to no liver fibrosis (Ishak ≥ 1) was 0.40; the corresponding specificity was 0.80. The differentiation of advanced liver fibrosis or cirrhosis (Ishak ≥ 4) compared to other stages of liver fibrosis was 0.75, with a specificity of 0.81. (4) Conclusions: This study shows that the ICG test, as a non-invasive diagnostic test, is able to differentiate patients with no liver fibrosis from patients with advanced liver fibrosis and liver cirrhosis. The ICG test seems to be helpful in monitoring patients with liver fibrosis regarding compensation levels, thus potentially enabling physicians to both detect progression from compensated liver fibrosis to advanced liver fibrosis and cirrhosis and to initiate antifibrotic treatment at an earlier stage. Full article

(This article belongs to the Special Issue Imaging of Hepatitis)

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17 pages, 1888 KiB

Open AccessArticle

Predictive Value of [^99mTc]-MAA-Based Dosimetry in Hepatocellular Carcinoma Patients Treated with [⁹⁰Y]-TARE: A Single-Center Experience

by Michael Doppler, Marlene Reincke, Dominik Bettinger, Katharina Vogt, Jakob Weiss, Michael Schultheiss, Wibke Uller, Niklas Verloh and Christian Goetz

Diagnostics 2023, 13(14), 2432; https://doi.org/10.3390/diagnostics13142432 - 20 Jul 2023

Cited by 1 | Viewed by 1083

Abstract

Transarterial radioembolization is a well-established method for the treatment of hepatocellular carcinoma. The tolerability and incidence of hepatic decompensation are related to the doses delivered to the tumor and healthy liver. This retrospective study was performed at our center to evaluate whether tumor- and healthy-liver-absorbed dose levels in TARE are predictive of tumor response according to the mRECIST 1.1 criteria and overall survival. One hundred and six patients with hepatocellular carcinoma were treated with [⁹⁰Y]-loaded resin microspheres and completed the follow-up. The dose delivered to each compartment was calculated using a compartmental model. The model was based on [^99mTc]-labelled albumin aggregate images obtained before the start of therapy. Tumor response was assessed after three months of treatment. Kaplan-Meier analysis was used to assess survival. The mean age of our population was 66 ± 13 years with a majority being BCLC B tumors. Forty-two patients presented with portal vein thrombosis. The response rate was 57% in the overall population and 59% in patients with thrombosis. Target-to-background (TBR) values measured on initial [^99mTc]MAA-SPECT-imaging and tumor model dosimetric values were associated with tumor response (p < 0.001 and p = 0.009, respectively). A dosimetric threshold of 136.5 Gy was predictive of tumor response with a sensitivity of 84.2% and specificity of 89.4%. Overall survival was 24.1 months [IQR 13.1–36.4] for patients who responded to treatment compared to 10.4 months [IQR 6.3–15.9] for the remaining patients (p = 0.022). In this cohort, the initial [^99mTc]MAA imaging is predictive of response and survival. The dosimetry prior to the application of TARE can be used for treatment planning and our results also suggest that the therapy is well-tolerated. In particular, hepatic decompensation can be predicted even in the presence of PVT. Full article

(This article belongs to the Special Issue Imaging of Hepatitis)

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10 pages, 1851 KiB

Open AccessArticle

Water–Fat Separated T1 Mapping in the Liver and Correlation to Hepatic Fat Fraction

by Claudia Fellner, Marcel Dominik Nickel, Stephan Kannengiesser, Niklas Verloh, Christian Stroszczynski, Michael Haimerl and Lukas Luerken

Diagnostics 2023, 13(2), 201; https://doi.org/10.3390/diagnostics13020201 - 5 Jan 2023

Cited by 4 | Viewed by 1725

Abstract

(1) Background: T1 mapping in magnetic resonance imaging (MRI) of the liver has been proposed to estimate liver function or to detect the stage of liver disease, among others. Thus far, the impact of intrahepatic fat on T1 quantification has only been sparsely discussed. Therefore, the aim of this study was to evaluate the potential of water–fat separated T1 mapping of the liver. (2) Methods: A total of 386 patients underwent MRI of the liver at 3 T. In addition to routine imaging techniques, a 3D variable flip angle (VFA) gradient echo technique combined with a two-point Dixon method was acquired to calculate T1 maps from an in-phase (T1_in) and water-only (T1_W) signal. The results were correlated with proton density fat fraction using multi-echo 3D gradient echo imaging (PDFF) and multi-echo single voxel spectroscopy (PDFF_MRS). Using T1_in and T1_W, a novel parameter FF_T1 was defined and compared with PDFF and PDFF_MRS. Furthermore, the value of retrospectively calculated T1_W (T1_W_calc) based on T1_in and PDFF was assessed. Wilcoxon test, Pearson correlation coefficient and Bland–Altman analysis were applied as statistical tools. (3) Results: T1_in was significantly shorter than T1_W and the difference of both T1 values was correlated with PDFF (R = 0.890). FF_T1 was significantly correlated with PDFF (R = 0.930) and PDFF_MRS (R = 0.922) and yielded only minor bias compared to both established PDFF methods (0.78 and 0.21). T1_W and T1_W_calc were also significantly correlated (R = 0.986). (4) Conclusion: T1_W acquired with a water–fat separated VFA technique allows to minimize the influence of fat on liver T1. Alternatively, T1_W can be estimated retrospectively from T1_in and PDFF, if a Dixon technique is not available for T1 mapping. Full article

(This article belongs to the Special Issue Imaging of Hepatitis)

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15 pages, 4883 KiB

Open AccessArticle

Contrast-Enhanced Ultrasonography with Arrival Time Parametric Imaging as a Non-Invasive Diagnostic Tool for Liver Cirrhosis

by Raluca Lupușoru, Ioan Sporea, Iulia Rațiu, Diana Lungeanu, Alina Popescu, Mirela Dănilă, Ruxandra Mare, Luciana Marc, Andrada Lascău, Tudor Voicu Moga, Felix Bende, Ana-Maria Ghiuchici and Roxana Șirli

Diagnostics 2022, 12(12), 3013; https://doi.org/10.3390/diagnostics12123013 - 1 Dec 2022

Cited by 2 | Viewed by 1216

Abstract

Liver biopsy is the gold standard method for staging liver fibrosis, but it is an invasive procedure that is associated with some complications. There are also non-invasive techniques for assessing liver fibrosis, such as elastography and biological tests, but these techniques can fail in detection or generate false measurements depending on the subject’s condition. This study aimed to determine whether liver fibrosis can be evaluated using contrast-enhanced ultrasonography with arrival time parametric imaging using the ultrasound machine’s parametric image software, the method being called (CEUS-PAT). CEUS-PAT was performed on each subject using SonoVue as a contrast agent, and images showing liver parenchyma and the right kidney on a single screen were used for analysis in parametric imaging, which was performed using the proprietary software of the ultrasound system. The ratio between the kidney and liver arrival times was calculated. The study included 64 predominantly male (56.3%) subjects, 37 cirrhotic patients, and 27 healthy volunteers, with a mean age of 58.98 ± 8.90 years. Significant differences were found between the liver cirrhosis and healthy groups regarding CEUS-PAT, 0.83 ± 0.09 vs. 0.49 ± 0.11, p < 0.0001. The correlation between CEUS-PAT and VCTE was r = 0.81. The optimal cut-off value for detecting liver cirrhosis was >0.7, with an AUC of 0.98, p < 0.001, Se = 89.19%, Sp = 100%, PPV = 100%, and NPV = 87.1%. We demonstrate that CEUS-PAT achieves excellent performance in diagnosing liver cirrhosis and is a fast method for diagnosing liver cirrhosis that can even be applied in situations where the use of other methods is excluded. Full article

(This article belongs to the Special Issue Imaging of Hepatitis)

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15 pages, 4966 KiB

Open AccessArticle

Application of A U-Net for Map-like Segmentation and Classification of Discontinuous Fibrosis Distribution in Gd-EOB-DTPA-Enhanced Liver MRI

by Quirin David Strotzer, Hinrich Winther, Kirsten Utpatel, Alexander Scheiter, Claudia Fellner, Michael Christian Doppler, Kristina Imeen Ringe, Florian Raab, Michael Haimerl, Wibke Uller, Christian Stroszczynski, Lukas Luerken and Niklas Verloh

Diagnostics 2022, 12(8), 1938; https://doi.org/10.3390/diagnostics12081938 - 11 Aug 2022

Cited by 2 | Viewed by 1512

Abstract

We aimed to evaluate whether U-shaped convolutional neuronal networks can be used to segment liver parenchyma and indicate the degree of liver fibrosis/cirrhosis at the voxel level using contrast-enhanced magnetic resonance imaging. This retrospective study included 112 examinations with histologically determined liver fibrosis/cirrhosis grade (Ishak score) as the ground truth. The T1-weighted volume-interpolated breath-hold examination sequences of native, arterial, late arterial, portal venous, and hepatobiliary phases were semi-automatically segmented and co-registered. The segmentations were assigned the corresponding Ishak score. In a nested cross-validation procedure, five models of a convolutional neural network with U-Net architecture (nnU-Net) were trained, with the dataset being divided into stratified training/validation (n = 89/90) and holdout test datasets (n = 23/22). The trained models precisely segmented the test data (mean dice similarity coefficient = 0.938) and assigned separate fibrosis scores to each voxel, allowing localization-dependent determination of the degree of fibrosis. The per voxel results were evaluated by the histologically determined fibrosis score. The micro-average area under the receiver operating characteristic curve of this seven-class classification problem (Ishak score 0 to 6) was 0.752 for the test data. The top-three-accuracy-score was 0.750. We conclude that determining fibrosis grade or cirrhosis based on multiphase Gd-EOB-DTPA-enhanced liver MRI seems feasible using a 2D U-Net. Prospective studies with localized biopsies are needed to evaluate the reliability of this model in a clinical setting. Full article

(This article belongs to the Special Issue Imaging of Hepatitis)

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9 pages, 1654 KiB

Open AccessArticle

MELIF, a Fully Automated Liver Function Score Calculated from Gd-EOB-DTPA-Enhanced MR Images: Diagnostic Performance vs. the MELD Score

by Carolina Río Bártulos, Karin Senk, Ragnar Bade, Mona Schumacher, Jan Plath, Nico Kaiser, Isabel Wiesinger, Sylvia Thurn, Christian Stroszczynski, Abdelouahed El Mountassir, Mathis Planert, Jan Woetzel and Philipp Wiggermann

Diagnostics 2022, 12(7), 1750; https://doi.org/10.3390/diagnostics12071750 - 20 Jul 2022

Cited by 2 | Viewed by 1373

Abstract

In the management of patients with chronic liver disease, the assessment of liver function is essential for treatment planning. Gd-EOB-DTPA-enhanced MRI allows for both the acquisition of anatomical information and regional liver function quantification. The objective of this study was to demonstrate and evaluate the diagnostic performance of two fully automatically generated imaging-based liver function scores that take the whole liver into account. T1 images from the native and hepatobiliary phases and the corresponding T1 maps from 195 patients were analyzed. A novel artificial-intelligence-based software prototype performed image segmentation and registration, calculated the reduction rate of the T1 relaxation time for the whole liver (rrT1_liver) and used it to calculate a personalized liver function score, then generated a unified score—the MELIF score—by combining the liver function score with a patient-specific factor that included weight, height and liver volume. Both scores correlated strongly with the MELD score, which is used as a reference for global liver function. However, MELIF showed a stronger correlation than the rrT1_liver score. This study demonstrated that the fully automated determination of total liver function, regionally resolved, using MR liver imaging is feasible, providing the opportunity to use the MELIF score as a diagnostic marker in future prospective studies. Full article

(This article belongs to the Special Issue Imaging of Hepatitis)

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