Abdominal Radiology

, Volume 44, Issue 3, pp 894–902 | Cite as

Magnetic resonance elastography SE-EPI vs GRE sequences at 3T in a pediatric population with liver disease

  • Juan S. Calle-Toro
  • Suraj D. SeraiEmail author
  • Erum A. Hartung
  • David J. Goldberg
  • Bradley D. BolsterJr.
  • Kassa Darge
  • Sudha A. Anupindi



The goal of our study is to compare hepatic stiffness measures using gradient-recalled echo (GRE) versus spin-echo echo planar imaging (SE-EPI)-based MR Elastography (MRE) at 3T used to measure hepatic stiffness in a patients with suspected liver diseases.

Materials and methods

This retrospective study included 52 patients with liver disease who underwent a 3T MRE exam including both an investigational SE-EPI-based technique and a product GRE-based technique. Regions of interest (ROI) were placed on the elastograms to measure elastography-derived liver stiffness as well as the area included within the ROIs. The mean liver stiffness values and area of ROIs were compared.


The mean liver stiffness was 3.72 kilopascal (kPa) ± 1.29 using GRE MRE and 3.78 kPa ± 1.13 using SE-EPI MRE. Measurement of liver stiffness showed excellent agreement between the two pulse sequences with a mean bias of − 0.1 kPa (range − 1.8 to 1.7 kPa) between sequences. The mean measurable ROI area was higher with SE-EPI (313.8 cm2 ± 213.8) than with the GRE technique (208.6 cm2 ± 114.8), and the difference was statistically significant (P < 0.05).


Our data shows excellent agreement of measured liver stiffness between GRE and SE-EPI-based sequences at 3T. Our results show the advantage of a SE-EPI MRE sequence in terms of image quality, ROI size and acquisition time with equivalent liver stiffness measurements as compared to GRE-MRE sequence.


Fibrosis Liver Magnetic resonance imaging MR elastography GRE MRE SE-EPI MRE 



We thank Carolina Maya MD (study coordinator), and Robert Carson BSRT (lead MRI technologist), of Children’s Hospital of Philadelphia; Richard L. Ehman, MD, PhD, and Scott Kruse, BS, of Mayo Clinic (Rochester, MN); and Christianne Leidecker, PhD, from Siemens Healthineers for their support and technical assistance related to 2D SE-EPI MRE.


  1. 1.
    Dhole, S.D., et al., Chronic Liver Diseases in Children: Clinical Profile and Histology. J Clin Diagn Res, 2015. 9(7): p. SC04-7.Google Scholar
  2. 2.
    Lobstein, T., et al., Child and adolescent obesity: part of a bigger picture. Lancet, 2015. 385(9986), p. 2510-20CrossRefGoogle Scholar
  3. 3.
    Wallihan, D.B., et al., Relationship of MR elastography determined liver stiffness with cardiac function after Fontan palliation. J Magn Reson Imaging, 2014. 40(6), p. 1328-35CrossRefGoogle Scholar
  4. 4.
    Serai, S.D., et al., Magnetic resonance elastography of the liver in patients status-post fontan procedure: feasibility and preliminary results. Congenit Heart Dis, 2014. 9(1), p. 7-14CrossRefGoogle Scholar
  5. 5.
    Gunay-Aygun, M., et al., Characteristics of congenital hepatic fibrosis in a large cohort of patients with autosomal recessive polycystic kidney disease. Gastroenterology, 2013. 144(1), p. 112-121.e2CrossRefGoogle Scholar
  6. 6.
    Rockey, D.C., et al., Liver biopsy. Hepatology, 2009. 49(3), p. 1017-44CrossRefGoogle Scholar
  7. 7.
    Cunha, G.M., et al., Feasibility and agreement of stiffness measurements using gradient-echo and spin-echo MR elastography sequences in unselected patients undergoing liver MRI. Br J Radiol, 2018. 91(1087), p. 20180126CrossRefGoogle Scholar
  8. 8.
    German, A.L., et al., Can reference images improve interobserver agreement in reporting liver fibrosis?. J Clin Pathol, 2018. 71(4), p. 368-371CrossRefGoogle Scholar
  9. 9.
    Jung, E.S., et al., Interobserver Agreement on Pathologic Features of Liver Biopsy Tissue in Patients with Nonalcoholic Fatty Liver Disease. J Pathol Transl Med, 2016. 50(3), p. 190-6CrossRefGoogle Scholar
  10. 10.
    Pournik, O., et al., Inter-observer and Intra-observer Agreement in Pathological Evaluation of Non-alcoholic Fatty Liver Disease Suspected Liver Biopsies. Hepat Mon, 2014. 14(1), p. e15167CrossRefGoogle Scholar
  11. 11.
    Maharaj B Fau - Maharaj, R.J., et al., Sampling variability and its influence on the diagnostic yield of percutaneous needle biopsy of the liver. (0140-6736 (Print)).Google Scholar
  12. 12.
    Ratziu, V., et al., Survival, liver failure, and hepatocellular carcinoma in obesity-related cryptogenic cirrhosis. Hepatology, 2002. 35(0270-9139 (Print)): p. 1485-93.Google Scholar
  13. 13.
    Bedossa, P., V. Dargere D Fau - Paradis, and V. Paradis, Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology, 2003. 38(0270-9139 (Print)): p. 1449-57.Google Scholar
  14. 14.
    Regev, A., et al., Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol, 2002. 97(0002-9270 (Print)): p. 2614-8.Google Scholar
  15. 15.
    Cadranel, J.F., F. Rufat P Fau - Degos, and F. Degos, Practices of liver biopsy in France: results of a prospective nationwide survey. For the Group of Epidemiology of the French Association for the Study of the Liver (AFEF). Hepatology, 2000. 32(0270-9139 (Print)): p. 477-81.Google Scholar
  16. 16.
    Froehlich, F., et al., Practice and complications of liver biopsy. Results of a nationwide survey in Switzerland. Dig Dis Sci, 1993. 38(0163-2116 (Print)): p. 1480-4.Google Scholar
  17. 17.
    Piccinino F Fau - Sagnelli, E., et al., Complications following percutaneous liver biopsy. A multicentre retrospective study on 68,276 biopsies. (0168-8278 (Print)).Google Scholar
  18. 18.
    Perrault J Fau - McGill, D.B., et al., Liver biopsy: complications in 1000 inpatients and outpatients. (0016-5085 (Print)).Google Scholar
  19. 19.
    Bravo, A.A., Sheth, S.G., Chopra, S., Liver Biopsy. New England Journal of Medicine, 2001. 344(7), p. 495-500CrossRefGoogle Scholar
  20. 20.
    Watanabe, A., et al., Magnetic resonance imaging of the cirrhotic liver: An update. World J Hepatol, 2015. 7(3). p. 468-87CrossRefGoogle Scholar
  21. 21.
    Serai, S.D., Towbin, A.J., Podberesky, D.J, Pediatric liver MR elastography. Dig Dis Sci, 2012. 57(10), p. 2713-9CrossRefGoogle Scholar
  22. 22.
    Trout, A.T., et al., Diagnostic Performance of MR Elastography for Liver Fibrosis in Children and Young Adults with a Spectrum of Liver Diseases. Radiology, 2018: p. 172099.Google Scholar
  23. 23.
    Xanthakos, S.A., et al., Use of magnetic resonance elastography to assess hepatic fibrosis in children with chronic liver disease. J Pediatr, 2014. 164(1), p. 186-8CrossRefGoogle Scholar
  24. 24.
    Serai, S.D., spin-echo echo-planar imaging Mr elastography versus gradient-echo Mr elastography for assessment of liver stiffness in children and Young adults suspected of having liver Disease. Radiology, 2016.Google Scholar
  25. 25.
    Chang, W., liver Fibrosis staging with Mr elastography: Comparison of Diagnostic Performance between Patients with Chronic Hepatitis B and Those with Other Etiologic Causes. Radiology, 2016.Google Scholar
  26. 26.
    Singh, S, et al., Magnetic resonance elastography for staging liver fibrosis in non-alcoholic fatty liver disease: a diagnostic accuracy systematic review and individual participant data pooled analysis. Eur Radiol, 2016. 26(5), p. 1431-40CrossRefGoogle Scholar
  27. 27.
    Shi, Y., Mr elastography for the assessment of hepatic Fibrosis in Patients with chronic hepatitis B infection: Does Histologic Necroinflammation Influence the Measurement of Hepatic Stiffness? Radiology, 2014.Google Scholar
  28. 28.
    Loomba, R., et al., Magnetic resonance elastography predicts advanced fibrosis in patients with nonalcoholic fatty liver disease: a prospective study. Hepatology, 2014. 60(6), p. 1920-8CrossRefGoogle Scholar
  29. 29.
    Yin, M., et al., Assessment of hepatic fibrosis with magnetic resonance elastography. Clin Gastroenterol Hepatol, 2017. 5(10), p. 1207-1213.e2CrossRefGoogle Scholar
  30. 30.
    DeLaPaz, R.L., Echo-planar imaging. Radiographics, 1994. 14(5), p. 1045-58CrossRefGoogle Scholar
  31. 31.
    Serai, S.D., et al., Cross-vendor validation of liver magnetic resonance elastography. Abdom Imaging, 2015. 40(4). p. 789-94CrossRefGoogle Scholar
  32. 32.
    Amatya, P., et al., Clinical and ultrasonographic measurement of liver size in normal children. Indian J Pediatr, 2014.0 81(5), p. 441-5CrossRefGoogle Scholar
  33. 33.
    Hallgren, K.A., Computing Inter-Rater Reliability for Observational Data: An Overview and Tutorial. Tutor Quant Methods Psychol, 2012.8(1), p. 2Google Scholar
  34. 34.
    Trout, A.T., et al., Prospective Assessment of Correlation between US Acoustic Radiation Force Impulse and MR Elastography in a Pediatric Population: Dispersion of US Shear-Wave Speed Measurement Matters. Radiology, 2016. 281(2), p. 544–552CrossRefGoogle Scholar
  35. 35.
    Serai S.D, et al.,Correlating liver stiffness with disease severity scoring system (DS3) values in Gaucher disease type 1 (GD1) patients. Mol Genet Metab, 2018. 123(3), p. 357-363CrossRefGoogle Scholar
  36. 36.
    Serai, S.D., Trout, A.T., Sirlin, C.B., Elastography to assess the stage of liver fibrosis in children: Concepts, opportunities, and challenges. Clinical Liver Disease, 2017. 9(1). p. 5-10CrossRefGoogle Scholar
  37. 37.
    Serai, S.D., spin-echo echo-planar imaging Mr elastography versus gradient-echo Mr elastography for assessment of liver stiffness in children and Young adults suspected of having liver Disease. Radiology, 2016. 0000, p. 10Google Scholar
  38. 38.
    Trout, A.T., et al., Liver Stiffness Measurements with MR Elastography: Agreement and Repeatability across Imaging Systems, Field Strengths, and Pulse Sequences. Radiology, 2016. 281(3), p. 793-804CrossRefGoogle Scholar
  39. 39.
    Herzka, D.A., et al., Magnetic resonance elastography in the liver at 3 Tesla using a second harmonic approach. Magn Reson Med, 2009. 62(2), p. 284-91CrossRefGoogle Scholar
  40. 40.
    Bae, J.S., et al., Magnetic resonance elastography of healthy livers at 3.0 T: Normal liver stiffness measured by SE-EPI and GRE. European Journal of Radiology, 2018. 107: p. 46-53.Google Scholar
  41. 41.
    Suraj, S., spin-echo echo-planar imaging Mr elastography versus gradient-echo Mr elastography for assessment of liver stiffness in children and Young adults suspected of having liver Disease. Radiology, 2016.Google Scholar
  42. 42.
    Wood R Fau - Bassett, K., et al.Google Scholar
  43. 43.
    Felker, E.R., et al., Liver MR Elastography at 3 T: Agreement Across Pulse Sequences and Effect of Liver R2* on Image Quality. AJR Am J Roentgenol, (2018). 211(3), p. 588-594CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Juan S. Calle-Toro
    • 1
  • Suraj D. Serai
    • 1
    • 4
    Email author
  • Erum A. Hartung
    • 2
    • 4
  • David J. Goldberg
    • 3
    • 4
  • Bradley D. BolsterJr.
    • 5
  • Kassa Darge
    • 1
    • 4
  • Sudha A. Anupindi
    • 1
    • 4
  1. 1.Division of Body Imaging, Department of RadiologyChildren’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Division of Nephrology, Department of PediatricsChildren’s Hospital of PhiladelphiaPhiladelphiaUSA
  3. 3.Division of Cardiology, Department of PediatricsChildren’s Hospital of PhiladelphiaPhiladelphiaUSA
  4. 4.Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  5. 5.Siemens HealthineersMalvernUSA

Personalised recommendations