Mapping the liver: clinical application

Abdominal magnetic resonance imaging (MRI) is a well-established modality with multiparametric capabilities. Liver fat, iron, and combined overload are common manifestations of diffuse liver diseases and may cause lipotoxicity and iron toxicity via oxidative hepatocellular injury, leading to progressive fibrosis, cirrhosis, and eventually, liver failure. Intracellular fat and iron cause characteristic changes in the tissue magnetic properties in predictable dose-dependent manners. The nonalcoholic fatty liver disease (NAFLD) is now believed to be the most common liver disease in Western countries, and encompasses a spectrum of disease stages, ranging from simple steatosis (called nonalcoholic fatty liver [NAFL]) to steatosis complicated by coexisting necroinflammation (nonalcoholic steatohepatitis[NASH]), progressive fibrosis, and cirrhosis. New advances in liver MRI including T1-, T2*-, and T1 rho mapping techniques, proton density fat fraction (PDFF) and elastography techniques may enable diagnosis of unseen pathologies by conventional methods in the liver. Also, Gd-EOB-DTPA can allow assessment of liver function by using postcontrast hepatobiliary phase or T1 reduction rate (normally above 60%). Shortly, MR fingerprinting may allow single slice acquisition and easy implementation of multiparametric MRI and follow-up of patients. These noninvasive imaging techniques serve an alternative or complementary role to invasive liver biopsy. Mapping techniques of the liver, for quantification of fat, iron, and fibrosis are increasingly being used in clinical practice, and may soon become standard of care.

Acknowledgements

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