Biomechanical Assessment of Liver Integrity: Prospective Evaluation of Mechanical Versus Acoustic MR Elastography
Authors: Koch Vitali , Gotta Jennifer , Chernyak Victoria , Cengiz Duygu , Torgashov Katerina , Eichler Katrin , Vilgrain Valérie , Martin Simon S. , Ziegengeist Nicole S. , Konrad Paul , Booz Christian , Yel Ibrahim , D'Angelo Tommaso , Mahmoudi Scherwin , Scholtz Jan‐Erik , Bernatz Simon , Alizadeh Leona S. , Cimprich Marina , Solim Levent A. , Thalhammer Axel , Gruber‐Rouh Tatjana , Hammerstingl Renate M. , Zeuzem Stefan , Finkelmeier Fabian , Pathil‐Warth Anita , Onay Melis , Kinzler Maximilian N. , Darwish Omar , Annio Giacomo , Taylor Stuart A. , Wild Peter , Dahmer Iulia , Herrmann Eva , Almansour Haidara , Vogl Thomas J. , Gruenewald Leon D. , Sinkus Ralph 
Published: August 2024

BackgroundMagnetic resonance elastography (MRE) can quantify tissue biomechanics noninvasively, including pathological hepatic states like metabolic dysfunction‐associated steatohepatitis.PurposeTo compare the performance of 2D/3D‐MRE using the gravitational (GT) transducer concept with the current commercial acoustic (AC) solution utilizing a 2D‐MRE approach. Additionally, quality index markers (QIs) were proposed to identify image pixels with sufficient quality for reliably estimating tissue biomechanics.Study TypeProspective.PopulationOne hundred seventy participants with suspected or confirmed liver disease (median age, 57 years [interquartile range (IQR), 46–65]; 66 females), and 11 healthy volunteers (median age, 31 years [IQR, 27–34]; 5 females).Field Strength/SequenceParticipants were scanned twice at 1.5 T and 60 Hz vibration frequency: first, using AC‐MRE (2D‐MRE, spin‐echo EPI sequence, 11 seconds breath‐hold), and second, using GT‐MRE (2D‐ and 3D‐MRE, gradient‐echo sequence, 14 seconds breath‐hold).AssessmentImage analysis was performed by four independent radiologists and one biomedical engineer. Additionally, superimposed analytic plane shear waves of known wavelength and attenuation at fixed shear modulus were used to propose pertinent QIs.Statistical TestsSpearman's correlation coefficient (r) was applied to assess the correlation between modalities. Interreader reproducibility was evaluated using Bland–Altman bias and reproducibility coefficients. P‐values <0.05 were considered statistically significant.ResultsLiver stiffness quantified via GT‐2D/3D correlated well with AC‐2D (r ≥ 0.89 [95% CI: 0.85–0.92]) and histopathological grading (r ≥ 0.84 [95% CI: 0.72–0.91]), demonstrating excellent agreement in Bland–Altman plots and between readers (κ ≥ 0.86 [95% CI: 0.81–0.91]). However, GT‐2D showed a bias in overestimating stiffness compared to GT‐3D. Proposed QIs enabled the identification of pixels deviating beyond 10% from true stiffness based on a combination of total wave amplitude, temporal sinusoidal nonlinearity, and wave signal‐to‐noise ratio for GT‐3D.ConclusionGT‐MRE represents an alternative to AC‐MRE for noninvasive liver tissue characterization. Both GT‐2D and 3D approaches correlated strongly with the established commercial approach, offering advanced capabilities in abdominal imaging compared to AC‐MRE.Evidence Level1Technical EfficacyStage 2