Yu Shun¹, Jieqin Lv², Zhongshuai Zhang³, Ma Mingping¹, and Lin Min-gui^1
1Radiology department, Fujian Provincial Hospital, fuzhou, China, ²Department of Biomedical Engineering, Southern Medical University, Guangzhou, China, ³Diagnostic Imaging, SIEMENS Healthcare, Shanghai, China

The increased obesity leads to ectopic fat deposits in liver and pancreas. Ectopic fat deposits affect insulin resistance and blood sugar content with Type 2 Diabetes. In order to assess the relationship between obesity and ectopic fat deposits and diabetes, this study used MR Dixon technique for the quantification of liver and pancreas fat fraction (FF) in T2DM patients and healthy controls.

Zhiyong John Yang¹, Dech Dokpuang ², Rinki Murphy ³, Reza Nemati ⁴, Xavier Yin ⁵, Kevin Haokun He ⁵, and Jun Lu^1
1School of Biomedical Science, Auckland University of Technology, Auckland, New Zealand, ²Auckland University of Technology, Auckland, New Zealand, ³University of Auckland, Auckland, New Zealand, ⁴. Canterbury Health Laboratories, Christchurch, New Zealand, ⁵Saint Kentigern College, Auckland, New Zealand

Pancreatic fat has been reported to be closely related to type 2 diabetes risk, hence is the subject of our investigation in a clinical trial. Artificial pancreatic fat quantification is an experienced operator based and time consuming task. In our recent task, a convolutional neural network were trained based on latest accurate artificial quantification method. Result showed the identification rate were significantly improved through the program.

Antonella Meloni¹, Mario Nobile², Laura Pistoia¹, Vincenzo Positano¹, Emanuele Grassedonio², Petra Keilberg¹, Costanza Bosi³, Luciana Rigoli⁴, Giulia Guerrini⁵, Alessandra De Mitrio⁶, Massimo Midiri², and Alessia Pepe^1
1MRI Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy, ²Policlinico "Paolo Giaccone", Palermo, Italy, ³Ospedale “G. Da Saliceto”, Piacenza, Italy, ⁴Policlinico "G. Martino", Messina, Italy, ⁵P.O. Misericordia Grosseto, Grosseto, Italy, ⁶A.S.L. di Bari, Bari, Italy

Pancreatic fat fraction should be included in the routine MRI examination of thalassemia major patients and employed as an index of increased risk for development of impaired glucose tolerance and overt diabetes mellitus.

Alexandre Triay Bagur^1,2, Ged Ridgway², Sir Michael Brady^2,3, and Daniel Bulte^1
1Department of Engineering Science, The University of Oxford, Oxford, United Kingdom, ²Perspectum Ltd, Oxford, United Kingdom, ³Department of Oncology, The University of Oxford, Oxford, United Kingdom

A method to automatically segment the pancreas into its main subcomponents head, body and tail is presented. The method uses groupwise registration to a reference template image that is subsequently annotated by parts. A new subject is registered to the template image, where part labels are propagated, and then transformed back to subject space. We test the method on the UK Biobank imaging sub-study, using a nominally healthy all-male cohort of 50 subjects for template creation and 20 other subjects for validation. We show pancreas T1 quantification by segment when reslicing the segmentation on a separate T1 slice.

Antonella Meloni¹, Mario Nobile², Laura Pistoia¹, Vincenzo Positano¹, Emanuele Grassedonio², Petra Keilberg¹, Francesco Sorrentino³, Maurizio Caniglia⁴, Annamaria Carrà⁵, Domenico Visceglie⁶, Massimo Midiri², and Alessia Pepe^1
1MRI Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy, ²Policlinico "Paolo Giaccone", Palermo, Italy, ³Ospedale "Sant'Eugenio", Roma, Italy, ⁴Azienda Ospedaliera "S. Maria Misericordia" di Perugia, Perugia, Italy, ⁵Ospedale “G. Da Saliceto”, Piacenza, Italy, ⁶Ospedale “Di Venere”, Bari, Italy

Pancreatic fatty replacement is present in more than three-quarters of patients with thalassemia major and it is associated with ageing. Pancreatic fatty replacement is associated to pancreatic iron overload, with a pancreatic T2* value <18 predicting its presence with a sensitivity of 75.6% and a specificity of 85.4%.

Edgar Adrian Castellanos¹, Susan Noworolski², Diana Alba³, Peter Hunt³, and Suneil Koliwad^3
1Department of Radiology and Biomedical Imaging, University of California , San Francisco, San Francisco, CA, United States, ²Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States, ³Department of Medicine and Diabetes Center, University of California, San Francisco, San Francisco, CA, United States

Individuals with HIV+ infection have a higher rate of progression to type 2 diabetes mellitus (T2DM), although the mechanisms are not fully understood. Pancreatic proton density fat fraction (PDFF) measures were shown to not differ between individuals with HIV+ (n=16) and controls (n=16). However, when stratified to high versus low measures of insulin resistance (using HOMA-IR), individuals with HIV+ infection (but not controls), who had high HOMA-IR had higher pancreatic PDFF than those with low HOMA-IR, p=0.01. These results suggest pancreatic PDFF may be useful to monitor in HIV+ infection. 

Ruiyang Zhao^1,2, Jitka Starekova¹, Scott B Reeder^1,2,3,4,5, and Diego Hernando^1,2
1Radiology, University of Wisconsin-Madison, Madison, WI, United States, ²Medical Physics, University of Wisconsin-Madison, Madison, WI, United States, ³Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States, ⁴Medicine, University of Wisconsin-Madison, Madison, WI, United States, ⁵Emergency Medicine, University of Wisconsin-Madison, Madison, WI, United States

Free breathing 2D flip angle modulated (FAM) CSE techniques along three separate orientations (axial/coronal/sagittal) were developed and validated for motion-robust free-breathing liver PDFF and R2* quantification. Six healthy volunteers were recruited and scanned at 3T. Promising results suggest that the proposed optimized 2D FAM CSE techniques along coronal and sagittal directions were able to avoid tissue slice gaps in the liver during free breathing acquisitions. Accurate quantification of PDFF and R2* were also observed with the proposed optimized techniques, as well as improved SNR performance compared to previously proposed low-flip angle 2D CSE.

Zhoubing Xu¹, Guillaume Chabin², Robert Grimm³, Stephan Kannengiesser³, Li Pan⁴, Vibhas Deshpande⁵, Gregor Thoermer³, Sasa Grbic¹, and Cara Morin^6
1Siemens Healthineers, Princeton, NJ, United States, ²Siemens Healthineers, Paris, France, ³Siemens Healthineers, Erlangen, Germany, ⁴Siemens Healthineers, Baltimore, MD, United States, ⁵Siemens Healthineers, Austin, TX, United States, ⁶St. Jude Children's Research Hospital, Memphis, TN, United States

Automated MRI liver segmentation enables the inline evaluation of parametric maps for iron quantification with improved accuracy, efficiency, and repeatability compared to manual efforts. Existing methods optimized for adults and normal livers do not perform well on challenging cases in children and patients with iron overload.  We developed a deep learning-based solution trained on 861 T1-weighted MRI that provided significantly improved liver segmentation compared to a commercially available solution and demonstrated its robustness on a challenging cohort of pediatric patients including cases with high iron content.

Gregory Simchick^1,2, Ruiyang Zhao^1,2, Gavin Hamilton³, Scott Reeder^1,2,4,5,6, and Diego Hernando^1,2,4
1Radiology, University of Wisconsin-Madison, Madison, WI, United States, ²Medical Physics, University of Wisconsin-Madison, Madison, WI, United States, ³Radiology, University of California-San Diego, San Diego, CA, United States, ⁴Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States, ⁵Medicine, University of Wisconsin-Madison, Madison, WI, United States, ⁶Emergency Medicine, University of Wisconsin-Madison, Madison, WI, United States

The relationships between several promising MR biomarkers of diffuse liver disease were evaluated at both 1.5T and 3T in subjects with liver iron overload using stimulated echo acquisition mode (STEAM) MRS. Multi-TE and multi-TE-TR sequences were acquired in order to obtain estimates of R1, R2, FWHM, and PDFF. Linear regression analysis was performed to evaluate the relationships between these various parameters and their relationships across field strengths. Several biomarkers demonstrated moderate to high correlations with each other, and the multi-TE-TR sequence (lower spectral resolution and higher number of spectra than the multi-TE sequence) tended to produce better correlations.

Diana Bencikova^1,2, Marcus Raudner¹, Sarah Poetter-Lang¹, Nina Bastati¹, Ahmed Ba-Ssalamah¹, Siegfried Trattnig^1,2, and Martin Krššák^2,3
1Department of Radiology, Medical University Vienna, Vienna, Austria, ²Christian Doppler Laboratory for Clinical Molecular Imaging, MOLIMA, Vienna, Austria, ³Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria

MRI-based T₂ mapping was suggested for the grading of hepatic parenchyma inflammation. Studies using multi-echo MRS suggest the effect of hepatic fat accumulation on T₂ values of the water signal. Here, we analyzed the effect of hepatic fat fraction on water T₂s in phantoms and patients in vivo with MRS and T₂ mapping based on fast radial turbo-spin-echo acquisition with fat saturation. While there was an effect in phantoms of low FF, in the population of patients with FF up to 15%, no significant influence could be observed. 

Hongru Jia¹, Chang Liu¹, Weiqiang Dou², Jing Ye¹, and Xianfu Luo^1
1Northern Jiangsu People’s Hospital, Yangzhou, China., Yangzhou, China, ²GE Healthcare,MR Research China, Beijing, China., Beijing, China

In this study, we aimed to investigate the feasibility of quantitative R2* mapping measured using multi-echo ultra-short echo time (multi-TE UTE) MRI for evaluating liver iron content coexisting with liver fat. Iron accumulation and fat deposition with different levels was built in rabbit liver in vivo. We found that the obtained R2* mapping measured with multi-TE UTE with fat suppression could accurate measure liver iron content at different levels without an influence from fat. With this finding, multi-TE UTE imaging can be considered a potential technique for noninvasive hepatic iron measurement.

Mark Zamskiy¹, Dominik Weidlich¹, Kilian Weiss², Marcus Makowski¹, Rickmer Braren¹, and Dimitrios Karampinos^1
1Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany, ²Philips Healthcare, Hamburg, Germany

Volumetric liver T2-weighted imaging and T2 mapping is of a high clinical significance but still remains very challenging due to motion in this region. The present work introduces a novel T2-prepared radial stack-of-stars (SoS) gradient echo sequence, which can be combined with a DIXON readout for achieving isotropic resolution fat-suppressed T2-weighted images. Moreover, the combination of the T2-prepared SoS acquisition with different T2-preparations enables T2 mapping in navigator-gated scans.

Ruvini Navaratna^1,2, Daiki Tamada², Gregory Simchick², Diego Hernando^1,2, and Scott B Reeder^1,2,3,4,5
1Medical Physics, University of Wisconsin - Madison, Madison, WI, United States, ²Radiology, University of Wisconsin - Madison, Madison, WI, United States, ³Biomedical Engineering, University of Wisconsin - Madison, Madison, WI, United States, ⁴Medicine, University of Wisconsin - Madison, Madison, WI, United States, ⁵Emergency Medicine, University of Wisconsin - Madison, Madison, WI, United States

MR-based relaxation parameters such as T2 are sensitive to iron content in the liver. Unfortunately, current T2 mapping techniques often suffer from long acquisition times. A recently introduced phase-based T2 mapping technique shows promise for rapid liver T2 quantification within a single breath-hold. However, its ability to quantify short T2 in liver iron overload is unknown. In this work, we present a modified 3D phase-based T2 mapping method for quantifying short T2 values encountered in liver iron overload. Our results demonstrate preliminary feasibility of phase-based RF modulated GRE to map short T2 values rapidly and accurately.

Manoj Mathew¹, Zhitao Li², Ali B Syed³, Shreyas S Vasanawala¹, and Ryan L Brunsing^1
1Department of Radiology, Stanford University, Palo Alto, CA, United States, ²Department of Radiology and Electrical Engineering, Stanford University, Palo Alto, CA, United States, ³Stanford University, Palo Alto, CA, United States

Radial Dual-Echo Inversion Recovery SPGR T1 mapping is a technique that yields water and fat separated parametric maps for the evaluation of T1 values in the liver parenchyma. This novel method can serve as an alternative to  SMART1 and MOLLI mapping techniques. From a cohort of 56 patients, we show the rIR-T1 outperforms MOLLI in the differentiation of patients with cirrhosis. We also show that the technique may be advantageous in the evaluation of patients with hepatic steatosis because of the ability to create composite and water-only images that yield T1 values that can better correlate to liver fibrosis.

Qing Wang¹, Ye Sheng², HaiFeng Liu², Zuhui Zhu², wei Xing², and Jilei Zhang^3
1Radiology, Third Affiliated Hospital of Soochow University & First People's Hospital of Changzhou, changzhou, China, ²Third Affiliated Hospital of Soochow University & First People's Hospital of Changzhou, changzhou, China, ³Healthcare,Shanghai,China, shanghai, China

We induced LF New Zealand white rabbits model by carbon tetrachloride to compare the diagnostic accuracy of parameters derived from the histogram analysis of precontrast, 10-min hepatobiliary phase (HBP) and 20-min HBP MOLLI T1 maps for staging liver fibrosis (LF). The mean, median, skewness, kurtosis, entropy, inhomogeneity and 10th/25th/75th/90th percentiles of T1_native, T1_10min and T1_20min were compared. The 75th of T1_native, entropy_10min, and entropy_20min were the three most reliable imaging markers in reflecting the stage of LF. The entropy derived from 20-min HBP T1 mapping is the best parameter for predicting the LF stage.

Omar Isam Darwish^1,2,3, Sami Jeljeli¹, Daniel Staeb⁴, Peter Speier⁵, Ralph Sinkus^1,2, and Radhouene Neji^1,3
1King's College London, London, United Kingdom, ²INSERM U1148, LVTS, University Paris Diderot, Paris, France, ³MR Research Collaborations, Siemens Healthcare Limited, Frimley, United Kingdom, ⁴MR Research Collaborations, Siemens Healthcare Limited, Melbourne, Australia, ⁵MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany

The increasing use of MR elastography (MRE) for the quantification of liver fibrosis and inflammation demands a rapid and accurate 3D MRE sequence. 3D MRE usually requires multiple breath-holds, which prolongs acquisition times and introduces misalignment between the different acquisitions.  We propose Intenso, a novel GRE-MRE sequence that enables 3D motion-encoding for volumetric MRE of the liver in a single breath-hold. The sequence combines simultaneous multi-slice excitation (SMS), Hadamard motion encoding and a multi-shot GRE-MRE sequence resulting in a total acquisition time of 17 seconds. In-vivo results are shown in three healthy volunteers and compared to a well-established GRE-MRE sequence.   

Zheng Zhu¹, Alina M. Allen², Terry Therneau³, Xin Lu¹, Kevin J. Glaser¹, Jiahui Li¹, Jingbiao Chen^1,4, Jie Chen^1,5, Safa Hoodeshenas¹, Sudhakar K. Venkatesh¹, Armando Manduca^1,6, Richard L. Ehman¹, and Meng Yin^1
1Department of Radiology, Mayo Clinic, Rochester, MN, United States, ²Devision of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States, ³Devision of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States, ⁴Department of Radiology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangdong, China, ⁵Department of Radiology, West China Hospital, Chengdu, Sichuan, China, ⁶Devision of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States

To identify individuals at high risk for rapid fibrosis progression, we retrospectively investigated longitudinal changes in liver stiffness measurements (LSM) and proton density fat fraction (PDFF) in 36 NAFLD patients. At the early fibrosis stages, the rate of change of LSM is slow and positively correlated with the rate of change in PDFF.  At later fibrosis stages, the rate of change in LSM is higher and is negatively correlated with ΔPDFF. Compared with other risk factors, the baseline value of LSM and the rate of change in PDFF was most strongly correlated with subsequent change in LSM.

Jie Yuan¹, Fan Mo², Yongming Dai², Suhao Qiu³, Yuan Feng³, Songhua Zhan¹, Yanwen Huang¹, and Hui Wang^1
1Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, 201203, Shanghai, China, ²MR Collaboration, United Imaging Healthcare, Shanghai, China, ³Institute for Medical Imaging Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, 200240, Shanghai, China

We investigated the potential of Ultrashort Echo Time (UTE) to accurately assess hepatic fibrosis in patients with chronic liver disease. Our study demonstrated that UTE has the potential to assess the hepatic fibrosis.

Christian Simonsson^1,2, Markus Karlsson¹, Patrik Nasr³, Ralph Sinkus⁴, Simone Ignatova⁵, Nils Dahlström¹, Mattias Ekstedt^2,3, Stergios Kechagias³, and Peter Lundberg^1,2
1Department of Radiation Physics, Radiology, Linköping University, Linköping, Sweden, ²Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden, ³Department of Medical and Health Sciences, Linköping University, Linköping, Sweden, ⁴Imaging Sciences & Biomedical Engineering, Kings College London,, London, United Kingdom, ⁵Linköping University, Linköping, Sweden

With the high prevalence of non-alcoholic fatty liver disease (NAFLD), it is important to have precise and non-invasive clinical methods to detect early stages of non-alcoholic steatohepatitis (NASH) and fibrosis progression. It has recently been shown that 3D Magnetic resonance elastography (3D-MRE) could be used to measure inflammation in the liver. To this cause, we investigated the association between liver 3D-MRE biomechanical properties and histopathological features in a liver study cohort of 25 patients including individuals with NASH. We here show that 3D-MRE biomechanical biomarkers show a correlation with higher degrees of hepatic inflammation in this cohort.

Zhiying Xue¹, Xiuzheng Yue², Yishi Wang², and Tong Zhang^1
1Radiology, No.4 Hospital of Harbin Medical University, Harbin, China, ²Philips Healthcare, Beijing, China

Synopsis: Liver fat content in patients with non-alcoholic fatty liver disease (NAFLD) is closely related to the progression of the disease. The objective of this study was to assess the effect of Vitamin K2 (VK2) supplementation on NAFLD using mDixon quant technique. Preliminary results showed supplementation of VK2 could can improve the  condition of liver fat deposition of VK2 and related biomarkers to some extent.