Jiejun Cheng¹, Dingxia Liu¹, Yunfei Zhang², Yongming Dai², and Xiuzhong Yao^1
1Shanghai Institute of Medical Imaging, Shanghai, China, ²MR Collaboration, Central Research Institute, United Imaging Healthcare, Shanghai, China

Keywords: Liver, Cancer

DWI is the most widely-used functional magnetic resonance imaging (MRI) technique in clinical practice. It has been widely acknowledged that DWI has the potential to probe tissue cellularity, microstructures, and microvasculature at a subvoxel-level. In this study, we aim to access the clinical application of the continuous-time random-walk (CTRW) model which recognizes intravoxel diffusion heterogeneity in both time and space in the preoperative evaluation of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) patients. Our results showed that diffusion parameters derived from CTRW model can be used as noninvasive quantitative imaging markers for preoperatively predicting the MVI of HCCs.

Maotong Liu¹, Tao Zhang¹, Xue-Qin Zhang¹, Lei Xu¹, and Xian-ce Zhao^2
1Affiliated Nantong Hospital 3 of Nantong University, Nantong, China, ²Philips Healthcare, Shanghai, China

Keywords: Liver, Cancer

The aim of this study was to compare the preoperative imaging findings of CK19-positive patients with HCC less than 3 cm with those of CK19-negative patients with small HCC to determine the prognosis of patients with CK19-positive small HCC after radical resection. We obtained the important predictive parameters of CK-19 positive small liver cancer patients by qualitatively and quantitatively comparing the imaging data and relevant clinical parameters of these patients before surgery. Our study showed that rim APHE in gadoxetic acid-enhanced MR imaging may help to predict early (2 years) postoperative recurrence in patients with CK19-positive small HCC.

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Yeon Ji Chae¹, Hwon Heo¹, Chul-Woong Woo², Sang-Tae Kim², Do-Wan Lee³, Monica Young Choi², Yoonseok Choi⁴, and Dong-Cheol Woo^1,2
1Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of, ²Convergence Medicine Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea, Republic of, ³Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of, ⁴Medical Research Institute, Gangneung Asan Hospital, Gangneung-si, Gangwon-do, Korea, Republic of

Keywords: Liver, Tumor, Magnetic resonance imaging, Liver microenvironment, Nonalcoholic steatohepatitis, Hepatocellular carcinoma

In this study, a syngeneic orthotopic hepatocellular carcinoma (HCC) rat model with nonalcoholic steatohepatitis (NASH) was established to elucidate the role of the liver microenvironment using MRI. Our findings demonstrated that the HCC growth and progression were accelerated by the disease severity of NASH in the syngeneic orthotopic HCC rat model. This suggests that the liver microenvironment is important for HCC promotion.

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Jiyun Zhang¹, Tao Zhang¹, Xueqin Zhang¹, and Xiance Zhao^2
1Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu Province, China, ²Philips Healthcare, Shanghai, China

Keywords: Liver, Tumor, early recurrence

Synopsis: The purpose of this study is to determine whether preoperative gadoxetic acid-enhanced MRI combined with microvascular invasion can effectively improve the predictive efficacy of early recurrence in HCC. We retrospectively reviewed patients with HBV who underwent curative resection for HCC, analysed preoperative factors to develop a preoperative model, and analysed both preoperative factors and microvascular invasion to develop a pre-/postoperative prediction model. Our study showed that the preoperative and pre-/postoperative prediction models demonstrate good performance for predicting early recurrence, the AUC of the two prediction model better than only the MVI risk factor.  

Xiaojun Yang^1,2, Xiaohui Duan^1,2, Mengzhu Wang³, Zhuoheng Yan^1,2, Huijun Hu^1,2, and Jun Shen^1,2
1Sun Yat-Sen Memorial Hospital, Guangzhou, China, ²Sun Yat-Sen University, Guangzhou, China, ³MR Scientific Marketing, Siemens Healthineers Ltd, Guangzhou, China

Keywords: Liver, Diffusion/other diffusion imaging techniques

This study aimed to evaluate the feasibility of various diffusion metrics obtained from stretched exponential model (SEM), diffusion kurtosis (DK) and fractional-order calculus (FROC) models -based diffusion-weighted imaging (DWI) in differentiating benign from malignant liver lesions. The results demonstrated that, as non-Gaussian DWI models, the combination of SEM and FROC models showed good discriminative ability, which was able to differentiate benign and malignant liver lesions.

Xue Ren¹, Ying Zhao¹, Qingwei Song¹, Zhigang Wu², and Ailian Liu^1
1The First Affiliated Hospital of Dalian Medical University, Dalian, China, ²Clinical and Technical Support, Philips Healthcare, Shenzhen, China

Keywords: Liver, Liver

Detection of liver lesion remains challenge since the contrast to noise ratio is always changing after intravenous bolus injection of Gd-BOPTA between lesion and liver tissue. The purpose of the study was to compare the lesion-to-liver CNR for different schemes using different flip angle and delay time. The results shows that the protocol of 60min FA10°could be used as the preferred scanning parameter, it could also be used to save the scan time. 

Mengtian Lu¹, Xueqin Zhang¹, Tao Zhang¹, Qi Qu¹, Lei Xu¹, Jiyun Zhang¹, Maotong Liu¹, Jifeng Jiang¹, Wei Shen², and Xiance Zhao^2
1Nantong Third People's Hospital, Nantong, China, ²Philips Healthcare, Nantong, China

Keywords: Cancer, MR Value

This study explores the predictive value of gadoxetic acid-enhanced magnetic resonance imaging (MRI) features on the pathologic grade, microvascular invasion (MVI), and cytokeratin-19 (CK19) expression in hepatocellular carcinomas (HCC), and evaluates their association with postoperative recurrence of HCC. The main method is to investigate whether there are independent predictors of the above aggressive indicators in the gadoxetic acid-enhanced MRI features and clinical parameters. Our study shows that peritumoral enhancement, peritumoral hypointensity and rim enhancement could independently predict poor pathological grade, MVI and CK19, respectively. Consequently, these results may help HCC patients develop more appropriate treatment options.

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Yanxi Xiong¹, Ying Zhao ¹, Ailian Liu ¹, Xue Ren¹, Qihao Xu¹, and Qingwei Song^1
1The First Affiliated Hospital, Dalian Medical University, Dalian, China

Keywords: Liver, Cancer

Hepatocellular carcinoma (HCC) is viewed as the most frequent primary liver cancer and the third cause of cancer related death worldwide [1]. The 5-year overall survival rate is only 30–40% after surgical resection and 70% of patients have a tumor recurrence within 5 years [2]. we evaluated the discrimination power of Diffusion Kurtosis Imaging for predicting two-year early recurrence (ER) of hepatocellular carcinoma (HCC) after curative resection.Our resuts showed that DKI-based quantitative parameters might have acertain value inpredicting two-year early recurrence (ER) in HCC. 

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Jinhuan Xie¹, Liling Long¹, Chenhui Li¹, and Huiting Zhang^2
1The First Affiliated Hospital of Guangxi Medical University, Nanning, China, ²Siemens Healthineers, Wuhan, China

Keywords: Liver, Diffusion/other diffusion imaging techniques

This study aimed to evaluate the potential value of stretched exponential model (SEM) and fractional order calculus (FROC) diffusion model in predicting microvascular invasion (MVI) in hepatocellular carcinoma (HCC) before surgery. Our results showed that compared with MVI-negative group, MVI-positive group had significant lower DDC from SEM and D from FROC and significant higher α from SEM. DDC had the best diagnostic performance for MVI, D was next, and α was last. SEM and FROC models can predict the MVI of HCC, and the DDC, α, and D values were potential biomarkers in future clinical practice.

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Yavuz Muslu^1,2, Ty A. Cashen³, Sagar Mandava⁴, Diego Hernando^2,5, and Scott B. Reeder^1,2,5,6,7
1Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States, ²Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States, ³Global MR Applications and Workflow, GE Healthcare, Waukesha, WI, United States, ⁴Global MR Applications and Workflow, GE Healthcare, Atlanta, GA, United States, ⁵Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States, ⁶Department of Medicine, University of Wisconsin-Madison, Madison, WI, United States, ⁷Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, United States

Keywords: Liver, Image Reconstruction

Gadoxetic acid (GA)-enhanced hepatobiliary phase (HBP) T₁-weighted (T₁w) MRI is well established for the detection of focal liver lesions. Previously, we proposed a novel imaging method to improve T₁ contrast in GA-enhanced HBP T₁w images for the purpose of improved detection and characterization of liver lesions. The proposed method provides volumetric, high-resolution phase-sensitive inversion recovery (PSIR) T₁w images of the liver from a free-breathing image acquisition. This study focuses on the impact of flip angle and spoiling on image quality. Our findings indicate 6-8 degrees flip angle in combination with gradient spoiling provides optimal image quality and T₁ contrast.

Jiahao Zhou¹, Ruokun Li², Jing Guo³, Ingolf Sack³, and Fuhua Yan^2
1Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanhai, China, ²Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China, ³Department of Radiology, Charité–Universitätsmedizin Berlin, Berlin, Germany；Charitéplatz 1, 10117 Berlin, Germany, Berlin, Germany

Keywords: Liver, Cancer

Tumor-liver biomechanical interaction investigated by multifrequency MR elastography in patients with HCC 

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Narine Mesropyan¹, Christoph Katemann², Annerieke Heuvelink-Marck², Alexander Isaak¹, Dmitrij Kravchenko¹, Leon Bischoff¹, Ad Denissen², Claus Christian Pieper¹, Daniel Kuetting ¹, Ulrike Attenberger¹, and Julian Luetkens^1
1Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany, ²Philips Healthcare, Philips Healthcare, Hamburg, Germany

Keywords: Liver, Artifacts

Breathing artifacts in liver MRI lead to impaired image quality, decreased diagnostic confidence, and, as a consequence, longer acquisition times or repetitive examinations. To improve the image quality and scan efficiency we integrated a newly developed in-bore breathing guidance application for T2 weighted sequences with propeller acquisition (MultiVaneXD) (T2BG) and compared it to a conventional free-breathing acquisition method (T2conv). Our study results suggest that an active breathing guidance for T2w liver MRI sequences significantly reduces breathing artifacts and total scan times by 21% while maintaining high image quality.

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Johannes Raspe¹, Sean McTavish¹, Kilian Weiss², Johannes M. Peeters³, Dimitrios C. Karampinos¹, and Anh T. Van^1
1Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany, ²Philips GmbH Market DACH, Hamburg, Germany, ³Philips Healthcare, Eindhoven, Netherlands

Keywords: Liver, Diffusion/other diffusion imaging techniques

Motion is a major source of artifacts in liver diffusion-weighted (DW) imaging leading to severe signal loss. Physical information about motion is encoded in the phase of DW images based on a pulsed gradient spin-echo (PGSE) sequence. The present work proposes a methodology to estimate a phase-predicted attenuation (PPA) which correlates with the magnitude variation of DW images in motion-controlled phantom experiments and in vivo measurements. These phase-based predictions allow to isolate motion-related magnitude attenuation for further investigation of undesired signal loss effects and offer potential for refining algorithms to reduce magnitude loss in DW imaging of the liver.

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Kai Liu¹, Caixia Fu², Dominik Nickel³, Caizhong Chen¹, Haitao Sun¹, and Mengsu Zeng^1
1Radiology, Zhongshan Hospital, Fudan University, Shanghai, China, ²MR Collaboration, Siemens (Shenzhen) Magnetic Resonance Ltd., Shenzhen, China, ³MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany, Erlangen, Germany

Keywords: Liver, Data Acquisition, Deep-learning reconstruction

The HASTE sequence accelerated by deep learning (DL) reconstruction was used to perform liver T2-weighted imaging under a single breath-hold in a daily routine. Its image quality, including signal-to-noise ratio, contrast-to-noise ratio, artifacts, edge sharpness and slice continuity, was evaluated by comparing it with the conventional multi-breath-hold BLADE sequence. The result demonstrated that DL-accelerated HASTE could shorten the acquisition time remarkably while maintaining clinically satisfactory image quality.  

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Anupama Ramachandran¹, Nicole Seiberlich¹, Katherine Wright², Jacob Richardson², Nancy Dudek², Joel Morehouse², Mishal Mendiratta Lala², Vikas Gulani², and Hero Hussain^2
1Radiology, University of Michigan, Ann Arbor, MI, United States, ²University of Michigan, Ann Arbor, MI, United States

Keywords: Liver, Low-Field MRI, Abdomen

Abdominal MRI performed in 51 patients on a commercial 0.55T system were retrospectively and independently rated by two radiologists for diagnostic performance and image quality (IQ). Twenty-eight patients had comparison scans performed at higher field strengths. The clinical question was answered by both radiologists in all 51 cases performed at 0.55T, and the average IQ of all sequences was acceptable.  In the subset of patients with comparison studies, the average IQ scores were significantly higher at 0.55T for DWI. No statistically significant difference was seen in IQ for the other sequences. Total acquisition time was almost double at 0.55T.

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Lihua Chen¹, Daihong Liu¹, Qing Li², and Jiuquan Zhang^1
1Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China, ²MR Collaborations, Siemens Healthineers Ltd, Shanghai, China

Keywords: Liver, Liver, hepatobiliary phase

Conventional abdominal MRI requires breath-holds in clinical routine which restricts acquisition times. Thus, radial MRI with additional motion compensation is desirable to further improve the performance of free-breathing abdominal exams for routine clinical use. This study aims to evaluate the feasibility of free-breathing high-resolution hepatocyte-specific phase MRI of the liver using golden-angle radial sparse parallel imaging. The results suggest that high-resolution hepatocyte-specific phase MRI with GRASP may offers a flexible alternative to assess liver lesions in patients.

Dexin Yu¹, Liping Zuo¹, Yueming An¹, Jinlei Fan¹, and Bowen Wang^1
1Qilu Hospital of Shandong University, Jinan, China

Keywords: Liver, Cancer

Problem: To investigate the incremental value of abdominal adipose to identify postoperative early recurrence in hepatitis B virus (HBV) patients with hepatocellular carcinoma (HCC). Methods: Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) areas were measured in the third lumbar vertebra plane of T1-weighted images. Results: HCC with microvascular invasion, portal invasion, and satellite nodules patients had lower VAT and SAT areas. VAT and SAT areas were important risk factors for early recurrence. Conclusions: Decreased VAT and SAT areas have significant impact regarding the postoperative early recurrence and poorer HCC biological behavior in HBV patients with HCC.

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Ashok Kumar P Reddy¹, Nitin Jain¹, Harsh Agarwal¹, Rajdeep Das¹, Rajagopalan Sundaresan¹, Sajith Rajamani¹, Arnaud Guidon², Ramanna Sudhir¹, Yang Baolian², Merry Mani³, M Ramasubba Reddy⁴, and Ramesh Venkatesan^1
1Engineering, Wipro GE HealthCare, Bangalore, India, ²GE HealthCare, Waukesha, WI, United States, ³University of Iowa, Iowa, IA, United States, ⁴IIT Madras, Chennai, India

Keywords: Liver, Body

Diffusion MRI in liver is key to detecting liver pathology. However, diffusion in abdomen is limited by its inability to use multi-channel surface coil for obese liver patients. Here we present a novel use of external gradient echo and spin echo navigators for diffusion imaging with a single channel volume coil for providing distortion less diffusion images. We also extend and demonstrate this technique on multichannel coil for Diffusion in Brain.

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Eun Joo Park¹, Yedaun Lee¹, Ho Joon Lee¹, Jisook Yi¹, Joonsung Lee², Xinzeng Wang³, and Arnaud Guidon^4
1Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea, Republic of, ²GE Healthcare, Seoul, Korea, Republic of, ³GE Healthcare, Houston, TX, United States, ⁴GE Healthcare, Boston, MA, United States

Keywords: Liver, Liver

In dynamic contrast enhanced (DCE) liver MRI, fast image acquisition with free breathing comes in expense of artifacts and noise, the most notably streak artifacts. In our study, we evaluated de-streaking effect and image quality of free-breathing stack of star liver MRI acquisition with deep learning reconstruction. Application of deep learning reconstruction (DLR) provides improved image quality by removing streak artifact and noise in liver MR images.

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Uma Sharma¹, Sangeetha Gupta², Ritu Tyagi¹, Bhavya Dhawan², and Ankit Shokeen^2
1Department of Nuclear Magnetic Resonance, All India Institute of Medical Sciences, New Delhi, NEW DELHI, India, ²Amity Institute of Pharmacy (AIP), Amity University Uttar Pradesh, Noida Campus, Noida, India

Keywords: Liver, Cancer, MRI, Steatohepatitis-associated Hepatocellular Carcinoma, cow colustrum, therapy

Nutraceuticals is an emerging industry with the potential to cater the needs of many therapeutic domains, including cancer a major cause of health concerns. Despite the currently available therapeutics, complication and effective medical management of HCC, particularly at an advanced stage has several limitations. Hence, in the present study an alternative approach using an animal product cow colostrum as therapeutics for HCC is explored in STAM-induced non-alcoholic steatohepatitis-associated hepatocellular carcinoma in mice. If successful this might prove to be a very viable and effective management for NASH-associated HCC.