Magnetic Resonance Elastography in Primary Sclerosing Cholangitis: Interobserver Agreement for Liver Stiffness Measurement with Manual and Automated Methods

Safa Hoodeshenas, Christopher L. Welle, Patrick J. Navin, Bogdan Dzyubak, John E. Eaton, Richard Lorne Ehman, Sudhakar K Venkatesh

Research output: Contribution to journalArticle

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Abstract

Rationale and Objective: Primary sclerosing cholangitis, a chronic liver disease causes heterogeneous parenchymal changes and fibrosis. Liver stiffness measurement (LSM) with magnetic resonance Elastography (MRE) may be affected by this heterogeneous distribution. We evaluated interobserver agreement of LSM in primary sclerosing cholangitis (PSC) with manual and automated methods to study the influence of heterogeneous changes. Materials and Methods: A total of 79 consecutive patients with PSC who had a liver MRI and MRE formed the study group. Three readers with 1–3 years’ experience in MRE and a MRE expert (11 years’ experience) independently performed LSM. Each reader manually drew free hand (fROI) and average (aROI) on stiffness maps. Automatic liver elasticity calculation (ALEC) was used to generate automated LSM. The expert fROI was the reference standard. Correlation analysis and absolute intra-class correlation coefficient (ICC) analysis was performed. Results: LSM data of 79 livers and 315 sections were evaluated. There was excellent ICC between expert and reader fROIs (0.989, 95% confidence interval, and 0.985–0.993) and aROIs (0.971, 95% confidence interval, and 0.953–0.983) and ALEC (0.972, 0.957–0.982) with fROI performing better. The areas measured with fROIs and ALEC had moderate ICC with Expert fROI (0.64 and 0.56, respectively) whereas aROI area had a poor ICC of 0.12. Comparison of multiple methods showed significant differences in LSM between expert fROI and aROI of two readers and no significant differences for fROIs of all three readers. Conclusion: LSM with MRE in PSC patients shows excellent interobserver agreement with both fROI and aROI methods with better performance with fROI. fROI may therefore be preferred for LSM measurements in PSC.

Original languageEnglish (US)
JournalAcademic radiology
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

Fingerprint

Elasticity Imaging Techniques
Sclerosing Cholangitis
Liver
Elasticity
Confidence Intervals
Liver Diseases

Keywords

  • Interobserver agreement
  • Liver stiffness
  • Magnetic resonance elastography
  • Primary sclerosing cholangitis
  • Reproducibility

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Magnetic Resonance Elastography in Primary Sclerosing Cholangitis : Interobserver Agreement for Liver Stiffness Measurement with Manual and Automated Methods. / Hoodeshenas, Safa; Welle, Christopher L.; Navin, Patrick J.; Dzyubak, Bogdan; Eaton, John E.; Ehman, Richard Lorne; Venkatesh, Sudhakar K.

In: Academic radiology, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Rationale and Objective: Primary sclerosing cholangitis, a chronic liver disease causes heterogeneous parenchymal changes and fibrosis. Liver stiffness measurement (LSM) with magnetic resonance Elastography (MRE) may be affected by this heterogeneous distribution. We evaluated interobserver agreement of LSM in primary sclerosing cholangitis (PSC) with manual and automated methods to study the influence of heterogeneous changes. Materials and Methods: A total of 79 consecutive patients with PSC who had a liver MRI and MRE formed the study group. Three readers with 1–3 years’ experience in MRE and a MRE expert (11 years’ experience) independently performed LSM. Each reader manually drew free hand (fROI) and average (aROI) on stiffness maps. Automatic liver elasticity calculation (ALEC) was used to generate automated LSM. The expert fROI was the reference standard. Correlation analysis and absolute intra-class correlation coefficient (ICC) analysis was performed. Results: LSM data of 79 livers and 315 sections were evaluated. There was excellent ICC between expert and reader fROIs (0.989, 95{\%} confidence interval, and 0.985–0.993) and aROIs (0.971, 95{\%} confidence interval, and 0.953–0.983) and ALEC (0.972, 0.957–0.982) with fROI performing better. The areas measured with fROIs and ALEC had moderate ICC with Expert fROI (0.64 and 0.56, respectively) whereas aROI area had a poor ICC of 0.12. Comparison of multiple methods showed significant differences in LSM between expert fROI and aROI of two readers and no significant differences for fROIs of all three readers. Conclusion: LSM with MRE in PSC patients shows excellent interobserver agreement with both fROI and aROI methods with better performance with fROI. fROI may therefore be preferred for LSM measurements in PSC.",
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T2 - Interobserver Agreement for Liver Stiffness Measurement with Manual and Automated Methods

AU - Hoodeshenas, Safa

AU - Welle, Christopher L.

AU - Navin, Patrick J.

AU - Dzyubak, Bogdan

AU - Eaton, John E.

AU - Ehman, Richard Lorne

AU - Venkatesh, Sudhakar K

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AB - Rationale and Objective: Primary sclerosing cholangitis, a chronic liver disease causes heterogeneous parenchymal changes and fibrosis. Liver stiffness measurement (LSM) with magnetic resonance Elastography (MRE) may be affected by this heterogeneous distribution. We evaluated interobserver agreement of LSM in primary sclerosing cholangitis (PSC) with manual and automated methods to study the influence of heterogeneous changes. Materials and Methods: A total of 79 consecutive patients with PSC who had a liver MRI and MRE formed the study group. Three readers with 1–3 years’ experience in MRE and a MRE expert (11 years’ experience) independently performed LSM. Each reader manually drew free hand (fROI) and average (aROI) on stiffness maps. Automatic liver elasticity calculation (ALEC) was used to generate automated LSM. The expert fROI was the reference standard. Correlation analysis and absolute intra-class correlation coefficient (ICC) analysis was performed. Results: LSM data of 79 livers and 315 sections were evaluated. There was excellent ICC between expert and reader fROIs (0.989, 95% confidence interval, and 0.985–0.993) and aROIs (0.971, 95% confidence interval, and 0.953–0.983) and ALEC (0.972, 0.957–0.982) with fROI performing better. The areas measured with fROIs and ALEC had moderate ICC with Expert fROI (0.64 and 0.56, respectively) whereas aROI area had a poor ICC of 0.12. Comparison of multiple methods showed significant differences in LSM between expert fROI and aROI of two readers and no significant differences for fROIs of all three readers. Conclusion: LSM with MRE in PSC patients shows excellent interobserver agreement with both fROI and aROI methods with better performance with fROI. fROI may therefore be preferred for LSM measurements in PSC.

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KW - Magnetic resonance elastography

KW - Primary sclerosing cholangitis

KW - Reproducibility

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