Reproducibility of hepatic MR elastography across field strengths, pulse sequences, scan intervals, and readers

  • Hye Jin Kim
  • Bohyun KimEmail author
  • Hyun Jeong Yu
  • Jimi Huh
  • Jei Hee Lee
  • Seung Soo Lee
  • Kyung Won Kim
  • Jai Keun Kim



To evaluate the reproducibility of hepatic MRE under various combinations of settings of field strength, pulse sequence, scan interval, and reader in non-alcoholic fatty liver disease (NAFLD) patients.


Adult NAFLD patients were prospectively enrolled for serial hepatic MRE with 1.5 T using 2D GRE sequence and 3.0 T using 2D SE-EPI sequence on the same day and after 2 weeks, resulting a total of four MRE examinations per patient. Three readers with various levels of background knowledge in MRE technique and liver anatomy measured liver stiffness after a training session. Linear regression, Bland–Altman analysis, within-subject coefficient of variation, and reproducibility coefficient (RDC) were used to determine reproducibility of hepatic MRE measurement.


Twenty patients completed the MRE sessions. Liver stiffness through MRE showed pooled RDC of 26% (upper 95% CI 30.6%) and corresponding limits of agreement (LOA) within 0.55 kPa across field strengths, MRE sequences, and 2-week interscan interval in three readers. Small mean biases and narrow LOA were observed among readers (0.05–0.19 kPa ± 0.53).


The magnitude of change across combinations of scan parameters is within acceptable clinical range, rendering liver stiffness through MRE a reproducible quantitative imaging biomarker. A lower reproducibility was observed for measurements under different field strengths/MRE sequences at a longer (2 weeks) interscan interval. Operators should be trained to acquire region of interest consistently in repeat examinations.


Magnetic resonance elastography Reproducibility of results Non-alcoholic fatty liver disease 



This work was supported by the new faculty research fund of Ajou University School of Medicine. The recipient of the fund is Bohyun Kim.


  1. 1.
    Yin M, Glaser KJ, Talwalkar JA, et al. (2016) Hepatic MR Elastography: Clinical Performance in a Series of 1377 Consecutive Examinations. Radiology 278:114-124. Scholar
  2. 2.
    Batheja M, Vargas H, Silva AM, et al. (2015) Magnetic resonance elastography (MRE) in assessing hepatic fibrosis: performance in a cohort of patients with histological data. Abdom Imaging 40:760-765. Scholar
  3. 3.
    Venkatesh SK, Wang G, Lim SG, Wee A (2014) Magnetic resonance elastography for the detection and staging of liver fibrosis in chronic hepatitis B. Eur Radiol 24:70-78. Scholar
  4. 4.
    Singh S, Venkatesh SK, Wang Z, et al. (2015) Diagnostic performance of magnetic resonance elastography in staging liver fibrosis: a systematic review and meta-analysis of individual participant data. Clin Gastroenterol Hepatol 13:440-451.e446. Scholar
  5. 5.
    Singh S, Venkatesh SK, Loomba R, et al. (2016) 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 26:1431-1440. Scholar
  6. 6.
    Manduca A, Oliphant TE, Dresner MA, et al. (2001) Magnetic resonance elastography: non-invasive mapping of tissue elasticity. Med Image Anal 5:237-254.CrossRefGoogle Scholar
  7. 7.
    Muthupillai R, Lomas DJ, Rossman PJ, et al. (1995) Magnetic resonance elastography by direct visualization of propagating acoustic strain waves. Science 269:1854-1857.CrossRefGoogle Scholar
  8. 8.
    Venkatesh SK, Ehman RL (2015) Magnetic resonance elastography of abdomen. Abdom Imaging 40:745-759. Scholar
  9. 9.
    Reiter R, Freise C, Johrens K, et al. (2014) Wideband MRE and static mechanical indentation of human liver specimen: sensitivity of viscoelastic constants to the alteration of tissue structure in hepatic fibrosis. J Biomech 47:1665-1674. Scholar
  10. 10.
    Dulai PS, Sirlin CB, Loomba R (2016) MRI and MRE for non-invasive quantitative assessment of hepatic steatosis and fibrosis in NAFLD and NASH: Clinical trials to clinical practice. J Hepatol 65:1006-1016. Scholar
  11. 11.
    Morisaka H, Motosugi U, Ichikawa S, et al. (2018) Magnetic resonance elastography is as accurate as liver biopsy for liver fibrosis staging. J Magn Reson Imaging 47:1268-1275. Scholar
  12. 12.
    Ajmera VH, Cachay E, Ramers C, et al. (2019) Novel MRI assessment of treatment response in HIV-associated NAFLD: a randomized trial of an SCD1 inhibitor (ARRIVE Trial). Hepatology. Scholar
  13. 13.
    Loomba R, Sirlin CB, Ang B, et al. (2015) Ezetimibe for the treatment of nonalcoholic steatohepatitis: assessment by novel magnetic resonance imaging and magnetic resonance elastography in a randomized trial (MOZART trial). Hepatology 61:1239-1250. Scholar
  14. 14.
    Jayakumar S, Middleton MS, Lawitz EJ, et al. (2019) Longitudinal correlations between MRE, MRI-PDFF, and liver histology in patients with non-alcoholic steatohepatitis: Analysis of data from a phase II trial of selonsertib. J Hepatol 70:133-141. Scholar
  15. 15.
    Cui J, Philo L, Nguyen P, et al. (2016) Sitagliptin vs. placebo for non-alcoholic fatty liver disease: A randomized controlled trial. J Hepatol 65:369-376. Scholar
  16. 16.
    Sullivan DC, Obuchowski NA, Kessler LG, et al. (2015) Metrology Standards for Quantitative Imaging Biomarkers. Radiology 277:813-825. Scholar
  17. 17.
    Raunig DL, McShane LM, Pennello G, et al. (2015) Quantitative imaging biomarkers: a review of statistical methods for technical performance assessment. Stat Methods Med Res 24:27-67. Scholar
  18. 18.
    Wang K, Manning P, Szeverenyi N, et al. (2017) Repeatability and reproducibility of 2D and 3D hepatic MR elastography with rigid and flexible drivers at end-expiration and end-inspiration in healthy volunteers. Abdom Radiol (NY) 42:2843-2854. Scholar
  19. 19.
    Hines CD, Bley TA, Lindstrom MJ, Reeder SB (2010) Repeatability of magnetic resonance elastography for quantification of hepatic stiffness. J Magn Reson Imaging 31:725-731. Scholar
  20. 20.
    Lee Y, Lee JM, Lee JE, et al. (2014) MR elastography for noninvasive assessment of hepatic fibrosis: reproducibility of the examination and reproducibility and repeatability of the liver stiffness value measurement. J Magn Reson Imaging 39:326-331. Scholar
  21. 21.
    Shire NJ, Yin M, Chen J, et al. (2011) Test-retest repeatability of MR elastography for noninvasive liver fibrosis assessment in hepatitis C. J Magn Reson Imaging 34:947-955. Scholar
  22. 22.
    Trout AT, Serai S, Mahley AD, et al. (2016) Liver Stiffness Measurements with MR Elastography: Agreement and Repeatability across Imaging Systems, Field Strengths, and Pulse Sequences. Radiology 281:793-804. Scholar
  23. 23.
    Serai SD, Obuchowski NA, Venkatesh SK, et al. (2017) Repeatability of MR Elastography of Liver: A Meta-Analysis. Radiology:161398. Scholar
  24. 24.
    Kim HJ, Cho HJ, Kim B, et al. (2019) Accuracy and precision of proton density fat fraction measurement across field strengths and scan intervals: A phantom and human study. J Magn Reson Imaging 50:305–314. Scholar
  25. 25.
    Chalasani N, Younossi Z, Lavine JE, et al. (2018) The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology 67:328-357. Scholar
  26. 26.
    Venkatesh SK, Yin M, Ehman RL (2013) Magnetic resonance elastography of liver: technique, analysis, and clinical applications. J Magn Reson Imaging 37:544-555. Scholar
  27. 27.
    Yin M, Talwalkar JA, Glaser KJ, et al. (2007) Assessment of hepatic fibrosis with magnetic resonance elastography. Clin Gastroenterol Hepatol 5:1207-1213.e1202. Scholar
  28. 28.
    Silva AM, Grimm RC, Glaser KJ, et al. (2015) Magnetic resonance elastography: evaluation of new inversion algorithm and quantitative analysis method. Abdom Imaging 40:810-817. Scholar
  29. 29.
    MR Elastograpy Biomarker Committee. MR Elastography of the Liver, Quantitative Imaging Biomarker Alliance. Prrofile Stage: Consensus. QIBA, May 2, 2018. Avilable from:
  30. 30.
    Rusak G, Zawada E, Lemanowicz A, Serafin Z (2015) Whole-organ and segmental stiffness measured with liver magnetic resonance elastography in healthy adults: significance of the region of interest. Abdom Imaging 40:776-782. Scholar
  31. 31.
    Wang Y, Ganger DR, Levitsky J, et al. (2011) Assessment of chronic hepatitis and fibrosis: comparison of MR elastography and diffusion-weighted imaging. AJR Am J Roentgenol 196:553-561. Scholar
  32. 32.
    Shin SU, Lee JM, Yu MH, et al. (2014) Prediction of esophageal varices in patients with cirrhosis: usefulness of three-dimensional MR elastography with echo-planar imaging technique. Radiology 272:143-153. Scholar
  33. 33.
    Yasar TK, Wagner M, Bane O, et al. (2016) Interplatform reproducibility of liver and spleen stiffness measured with MR elastography. J Magn Reson Imaging 43:1064-1072. Scholar
  34. 34.
    Serai SD, Yin M, Wang H, et al. (2015) Cross-vendor validation of liver magnetic resonance elastography. Abdom Imaging 40:789-794. Scholar
  35. 35.
    Wagner M, Besa C, Bou Ayache J, et al. (2016) Magnetic Resonance Elastography of the Liver: Qualitative and Quantitative Comparison of Gradient Echo and Spin Echo Echoplanar Imaging Sequences. Invest Radiol 51:575-581. Scholar
  36. 36.
    Mariappan YK, Dzyubak B, Glaser KJ, et al. (2017) Application of Modified Spin-Echo-based Sequences for Hepatic MR Elastography: Evaluation, Comparison with the Conventional Gradient-Echo Sequence, and Preliminary Clinical Experience. Radiology 282:390-398. Scholar
  37. 37.
    Serai SD, Dillman JR, Trout AT (2017) 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 282:761-770. Scholar
  38. 38.
    Zhan C, Kannengiesser S, Chandarana H, et al. (2019) MR elastography of liver at 3 Tesla: comparison of gradient-recalled echo (GRE) and spin-echo (SE) echo-planar imaging (EPI) sequences and agreement across stiffness measurements. Abdom Radiol (NY). Scholar
  39. 39.
    Kim YS, Jang YN, Song JS (2018) Comparison of gradient-recalled echo and spin-echo echo-planar imaging MR elastography in staging liver fibrosis: a meta-analysis. Eur Radiol 28:1709-1718. Scholar
  40. 40.
    Hsu C, Caussy C, Imajo K, et al. (2019) Magnetic Resonance vs Transient Elastography Analysis of Patients With Nonalcoholic Fatty Liver Disease: A Systematic Review and Pooled Analysis of Individual Participants. Clin Gastroenterol Hepatol 17:630-637.e638. Scholar

Copyright information

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

Authors and Affiliations

  1. 1.Department of Radiology, Ajou University School of MedicineAjou University HospitalYeongtong-guSouth Korea
  2. 2.Department of Radiology and Research Institute of Radiology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea

Personalised recommendations