Neeraja Mahalingam¹, Andrew Trout^2,3,4, Deep Gandhi¹, Ruchi Singh^5,6, Alexander Miethke^5,6, and Jonathan Dillman^2,3,5
1Imaging Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States, ²Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States, ³Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States, ⁴Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States, ⁵Center for Autoimmune Liver Disease, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States, ⁶Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Changes over time in liver and spleen T1 relaxation and MR elastography (MRE) measurements in children with autoimmune liver disease (AILD) have not been extensively studied as markers of disease. Iron (T2*)-corrected T1 (cT1) mapping and MRE were performed in 67 pediatric/young adult patients at baseline, 12, and 24 months. One-way ANOVA (mixed model) tests identified no statically significant changes in liver cT1 and liver and spleen stiffness over time but near-significant trends were identified. Further studies with larger sample sizes are needed to expand upon these preliminary results and define the roles of cT1 and MRE in clinical practice.

Lea Hitpass¹, Paul Felix Sieben¹, Vanessa Raaff¹, Philipp Bruners¹, Christiane K. Kuhl¹, and Alexandra Barabasch^1
1Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany

There is a substantial clinical need to identify patients who benefit from PVE procedure before undergoing major liver surgery. Elevated liver fat fraction is a frequent finding on pre-procedural MRI based on increasing rates of (non-) alcoholic fatty liver disease as well as chemotherapy-associated steato-hepatitis. Therefore, it was this studys aim to investigate the correlation of MRI-based liver fat fraction on hypertrophy rates after PVE.Including patients with colorectal liver metastases undergoing a single type of portal vein occlusion only there was no correlation found indicating that MRI-based high liver fat fraction should not discourage to perform PVE.

Alix C Hopp¹, Carolyn Mead-Harvey², and Alvin C Silva^1
1Radiology, Mayo Clinic Arizona, Phoenix, AZ, United States, ²Mayo Clinic Arizona, Phoenix, AZ, United States

Hepatocellular adenoma (HCA) is an uncommon benign tumor with risk for tumoral hemorrhage and malignant transformation. At least four HCA subtypes have been described: Inflammatory (I-HCA); hepatocyte nuclear factor 1-α mutated (H-HCA); β-catenin (B-HCA); and unclassified (U-HCA).  I-HCA has the highest risk for tumoral hemorrhage, whereas B-HCA is the most likely to undergo malignant transformation.  Clinical management differs for HCA subtypes, based on their different level of risk for complications. This study examines the image findings of pathologically proven HCAs from our institution on gadoxetic acid-enhanced MRI, in order to describe association between MRI image findings with HCA subtypes.

Hideaki Kutsuna¹, Hideki Ota^2,3, Yoshimori Kassai⁴, Hidenori Takeshima⁵, Tatsuo Nagasaka⁶, Takashi Nishina⁷, Yoshiaki Morita³, and Kei Takase^3,8
1MRI Systems Development Department, Canon Medical Systems Corporation, Kanagawa, Japan, ²Department of Advanced MRI Collaboration Research, Tohoku University Graduate School of Medicine, Miyagi, Japan, ³Department of Diagnostic Radiology, Tohoku University Hospital, Miyagi, Japan, ⁴CT-MR Solution Planning Department, Canon Medical Systems Corporation, Tochigi, Japan, ⁵Advanced Technology Research Department, Research and Development Center, Canon Medical Systems Corporation, Kanagawa, Japan, ⁶Department of Radiological Technology, Tohoku University Hospital, Miyagi, Japan, ⁷MRI Sales Department, Canon Medical Systems Corporation, Miyagi, Japan, ⁸Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Miyagi, Japan

The purpose is to provide improved time intensity curves (TICs) of dynamic contrast enhanced MRI. In this work, a method based on convolutional neural network (CNN) was compared with a conventional method based on compressed sensing (CS). While both of the methods used radial sampling for free-breathing acquisitions, reconstruction strategies were different.

The experimental results showed that, in comparison with the images reconstructed with CS, the images reconstructed with CNN exhibited higher temporal resolution in the TICs without losing spatial detail.

Xiang-Pan Meng¹, Yuan-Cheng Wang¹, and Shenghong Ju^1
1Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China

Given the fundamental role of imaging in predicting MVI, it is important to understand relative ability of different imaging modalities. However, whether CT and MRI have a comparable predictive performance for MVI is unknown. This study aimed to compare the performance of CT and MRI for prediction of MVI in solitary HCC and investigate added value of radiomics analysis for MVI prediction.

Bing Hu¹, Ziying Yin², Mengsi Li¹, Ying Deng¹, Sichi Kuang¹, Jun Chen², Linqi Zhang¹, Meng Yin², Kevin J. Glaser², Richard L. Ehman², and Jin Wang^1
1Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China, ²Radiology, Mayo Clinic, Rochester, MN, United States

The presence of microvascular invastion (MVI) at histopathology is an important predictive factor in managing hepatocellular carcinoma (HCC). We evaluated the potential of MRE-based shear strain mapping to assess adhesion characteristics at tumor boundaries and to non-invasively predict the presence of MVI. We retrospectively calculated maps displaying octahedral shear strain in exams of 61 HCC patients who underwent 3D multi-frequency MRE examinations. Results demonstrated that the prevalence of adherent tumor-liver parenchyma interface in positive MVI groups was significantly higher than negative groups. The results provide evidence that MRE-based shear strain mapping is helpful for non-invasive prediction of MVI in HCC.

Meng Yan¹, Xinming Li¹, Zhijun Geng², Zhendong Qi¹, Yingjie Mei³, and Xianyue Quan^1
1Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China, ²Department of Medical Imaging,Sun Yat-sen University Cancer Center, Guangzhou, China, ³Philips Healthcare, Guangzhou, China

Hepatic resection is the optimal treatment for patients with hepatocellular carcinoma (HCC) in the very early or early stage [Barcelona Clinic Liver Cancer (BCLC)0/A]. However, recurrence within 2 years occurs in 30%–50% of patients; hence, HCC is the major cause of mortality. This study aimed to develop and validate a clinical model to predict the early recurrence of HCC after curative resection. The proposed nomogram provided better discrimination than the BCLC stage and AJCC-TNM (eight edition).

Yanqiao Ren¹, Jingjie Yan², Lian Yang¹, Qingjia Bao³, Chaoyang Liu³, and Chuansheng Zheng^1
1Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China, Wuhan, China, ²Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, 430074, China., Wuhan, China, ³State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Wuhan Institute of Physics and Mathmatics, Innovation Academy for Precision Measurement Science and Technology, 430071Wuhan, China, Wuhan, China

Molecular and pathological characteristics of the tumor microenvironment have been shown to cause tumor heterogeneity and variability in therapeutic responses. We used functional MRI to evaluate the changes in tumor microenvironment after treatment with sorafenib and anti-PD-L1 antibody for hepatocellular carcinoma (HCC). The results indicated that DWI-MRI and MRS could dynamically assess microenvironmental changes including tumor necrosis and tumor hypoxia. The findings of this study are conducive to the establishment of an accurate correlation between imaging features-microenvironment characteristics-tumor anti-vascular treatment and immunotherapy, and the realization of scientific and precise individualized treatment of HCC.

Lili Fan¹, Ailian Liu¹, Jiazheng Wang², Liangjie Lin², Lihua Chen¹, Qingwei Song¹, Renwang Pu¹, Ying Zhao¹, Tao Lin¹, and Xue Ren^1
1The First Affiliated Hospital of Dalian Medical University, Dalian, China, ²Philips Healthcare, Beijing, China

Liver cancer and liver metastases are the most common liver malignancies. The accurate diagnosis of hepatocellular carcinoma (HCC) and hepatic metastasis (HM) is of great significance to the choice of treatment options. We aimed to explore the value of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) combined with T1 and T2 mapping to distinguish HCC from HM. Results showed that DCE combined with T1 and T2 mapping had the highest efficacy (AUC: 0.936; sensitivity: 81.8%; specificity: 100%).

Fei Wang¹, Juan Zhu¹, Yupei Zhang¹, and Mengxiao Liu^2
1Anqing municipal hospital, Anqing, China, ²MR scientific Marketing, Diagnostic Imaging, Siemens Healthcare Ltd, Shanghai, China

The diagnostic value of dual-flip angle (DFA) T1 mapping and DWI imaging in the diagnosis of benign and malignant focal liver lesions (FLLs) were compared.T1 mapping includes Native T1,Enhanced T1 in the equilibrium period of 2 minutes after Gd-DTPA enhancement,and T1 enhancement rate ΔT1%.In T1 mapping, the enhanced T1 value and ΔT1% have diagnostic sensitivity and specificity similar with DWI.The Native T1 value is superior to DWI in the differential diagnosis of liver cysts and hemangioma.T1 mapping has a promising future as a non invasive alternative method for biopsy identification of benign and malignant FLLs.

Hanyu Jiang^1,2, Bin Song¹, Yun Qin¹, Yi Wei¹, Kyle J. Lafata^2,3, Meghana Konanur², Matthew DF McInnes^4,5, and Mustafa R. Bashir^2,6,7
1Radiology, West China Hospital, Sichuan University, Chengdu, China, ²Radiology, Duke University Medical Center, Durham, NC, United States, ³Radiation Oncology, Duke University School of Medicine, Durham, NC, United States, ⁴Radiology, University of Ottawa, Ottawa, ON, Canada, ⁵Epidemiology, University of Ottawa, Ottawa, ON, Canada, ⁶Center for Advanced Magnetic Resonance in Medicine, Duke University Medical Center, Durham, NC, United States, ⁷Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC, United States

We aimed to propose a revised LI-RADS (rLI-RADS) for hepatocellular carcinoma (HCC) based on the LI-RADS version 2018 (v2018) major feature system on gadoxetate disodium (EOB)-enhanced MRI. We retrieved 224 consecutive at-risk patients with 742 LR-3 to LR-5 hepatic observations from a prospectively-collected database. In the training set, LI-RADS v2018 major features evaluated by three independent radiologists were used to develop rLI-RADS according to the likelihood of HCC. Compared with LI-RADS v2018, rLI-RADS was completely data-driven, remarkably simpler, and demonstrated significantly optimized diagnostic sensitivity and accuracy while maintaining reasonable specificity for HCC.

Bradley C Monteforte¹, Ali Agely¹, Manoj Mathew¹, Pejman Ghanouni¹, and Ryan L Brunsing^1
1Radiology, Stanford University, Palo Alto, CA, United States

In- and opposed-phase imaging has become integral in liver MR imaging due to its ability to identify intravoxel fat or iron, important ancillary features in lesion characterization, particularly during hepatocellular carcinoma surveillance. Potentially, these features can be assessed   through images acquired from dynamic contrast-enhanced imaging, rather than separate sequence acquisitions, decreasing scan times. Two blinded radiologists retrospectively reviewed MR liver examinations comparing in- and opposed-phase 2D-GRE imaging to 3D-SPGR Dixon imaging for the assessment of intralesional fat or iron. We found that there is no difference in fat or iron detection performance between dedicated 2D-GRE and 3D-SPGR Dixon sequences.  

Cai ming xi¹, Han dong ming¹, and Wang kai yu^2
1The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China, ²GE Healthcare, MR Research China, Beijing, China

In this study we assessed the feasibility of quantitative parameters derived from amide proton transfer (APT) and diffusion kurtosis imaging (DKI) in predicting the response to transcatheter arterial chemoembolization (TACE) treatment for hypervascular hepatocellular carcinoma (HCC). The combination model of quantitative parameters of APT and DKI showed good diagnostic performance in predicting the recurrence and postoperative liver decompensation. Therefore, APT and DKI can be used as potential imaging biomarkers to predict the effect of early-stage HCC after TACE treatment.

Ying Zhao¹, Ailian Liu¹, Tao Lin¹, Qingwei Song¹, Yu Yao^2,3, Han Wen^2,3, Xin Li⁴, Yan Guo⁴, and Tingfan Wu^4
1The First Affiliated Hospital of Dalian Medical University, Dalian, China, ²Chengdu Institute of Computer Application, Chinese Academy of Sciences, Chengdu, China, ³University of Chinese Academy of Sciences, Beijing, China, ⁴GE Healthcare (China), ShangHai, China

In the present study, contrast-enhanced MRI radiomics was demonstrated to be capable to predict therapeutic response in hepatocellular carcinoma treated with transcatheter arterial chemoembolization, which will provide some guidance for treatment decisions.

Fei Han¹ and Vibhas Deshpande^2
1US MR R&D, Siemens Medical Solutions, USA, Los Angeles, CA, United States, ²US MR R&D, Siemens Medical Solutions, USA, Austin, TX, United States

This study proposes a comprehensive strategy to accelerate a Radial-TSE acquisition for qualitative T2-weighted imaging and quantitative T2 mapping for body applications. A fast k-space calibration method, a radial de-streaking method based on geometric coil mixing and accelerated acquisition using multiple gradient-echo radial readout between 180° refocusing pulses were implemented. Preliminary validation in phantom and in-vivo experiments shows that the proposed method reduces the scan time of Radial-TSE by half without noticeable loss of image quality and quantification accuracy. The proposed method may allow more efficient acquisition and improve the clinical applicability of free-breathing abdominal T2 quantitative imaging.

Mengting Hu¹, Nan Wang¹, Ailian Liu¹, Qingwei Song¹, Renwang Pu¹, Lihua Chen¹, Jiazheng Wang², and Zhiwei Shen^2
1The First Affiliated Hospital of Dalian Medical University, Dalian, China, ²Philips Healthcare, Dalian, China

The occurrence and development of liver cirrhosis is accompanied by changes in portal vein blood flow and intrahepatic blood flow, which may eventually lead to liver implantation [1]. Liver-lobe-based IVIM-derived parameters can be associated with cirrhosis [2]. 4D flow-MRI could scope the portal vein blood flow [3]. In this study, we explored the correlation between the perfusion paraments and quantitative values of blood flow in patients with liver cirrhosis using IVIM and 4D flow-MRI, investigating the potential connections between portal vein flow changes and liver cirrhosis.

Jiachen Ji¹, Changchun Liu², Yunduo Li¹, Mingzhu Fu¹, Jinghui Dong², Jianming Cai², Chunsheng Chi³, Bo Jin³, Wen Shen⁴, Xiaolong Qi⁵, and Rui Li^1
1Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China, ²Department of Radiology, The Fifth Medical Centre of Chinese PLA General Hospital, Beijing, China, Beijing, China, ³First Liver Cirrhosis Diagnosis and Treatment Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China, Beijing, China, ⁴Department of Radiology, First Center Hospital of Tianjin, Tianjin, China, Tianjin, China, ⁵CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China, Lanzhou, China

Portal hypertension (PH) is a severe liver disease which could lead to gastroesophageal varices. Noninvasive methods to diagnose PH and to evaluate the risk of variceal bleeding are needed. 4D Flow MRI is an advanced technique which could provide visualization and quantification of blood flow. In the study, we identified the reproducibility of the processing and quantifying procedure of 4D Flow data and discovered the significant hemodynamic differences in portal vein between PH patients and controls using 4D Flow MRI. Additionally, we tested the performance of 4D Flow MRI in diagnosing PH and stratifying the risk of variceal bleeding.

Simon Chatelin¹, Raoul Pop^2,3, Céline Giraudeau², Khalid Ambarki⁴, Ning Jin⁵, François Séverac^1,6, Elodie Breton¹, and Jonathan Vappou^1
1ICube, UMR 7357 CNRS, University of Strasbourg, Strasbourg, France, ²IHU-Strasbourg, Institute of image-guided surgery, Strasbourg, France, ³Interventional Neuroradiology Department, University Hospitals of Strasbourg, Strasbourg, France, ⁴Siemens Healthcare SAS, Saint Denis, France, ⁵Siemens Medical Solutions USA, Inc., Chicago, IL, United States, ⁶Public Healthcare Department, University Hospitals Strasbourg, Strasbourg, France

Hepatic fibrosis causes an increase in the liver stiffness, a parameter measured by elastography and widely used as diagnosis method. This study aims at determining the extent to which a portal occlusion due to concomitant portal vein thrombosis can also affect these mechanical properties. Portal vein occlusion was generated by progressive inflations of a balloon catheter in the portal vein of four swines. The portal flow and liver stiffness were investigated using 4D-flow MRI and MR-Elastography. This vascular mechanism is shown to be sufficient to attenuate the increase in stiffness due to moderate fibrosis and may lead to false-negative diagnosis.

Huan-Huan Chong^1,2, Pei-Yun Zhou^3,4, Chun Yang², and Meng-Su Zeng^1,2,5
1Shanghai Institute of Medical Imaging, Shanghai, China, ²Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China, ³Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China, ⁴Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai, China, ⁵Department of Medical Imaging, Shanghai Medical College, Fudan University, Shanghai, China

Whether microvascular invasion (MVI) is a prognosis factor for small hepatocellular carcinoma (sHCC) is controversial, a preoperatively predictive model based on gadoxetate disodium (Gd-EOB-DTPA) MRI is clinical needed for MVI in sHCC.We concluded that alpha-fetoprotein>20 ng/mL, non-smooth margin, incomplete or absent capsule, peritumoral enhancement and larger tumor size were independent risk factors for MVI in patients with sHCC ≤3 cm. Although MVI independently impaired RFS before propensity score matching (PSM), it was ultimately identified as a potential but not an independent risk factor for recurrence in sHCC patients after PSM balancing the confounder — tumor size.