MRE: What It's Like
Mayo Clinic patient K. Anderson describes herself as "a 43-year-old fairly healthy mother of two." She recently volunteered to undergo an MRE exam. "Part of me just wanted to know how exactly someone could vibrate my liver ...the other part of me wanted to know why my liver enzymes are always a little high, something my family physician assures me is nothing to be concerned about."
"On my day off, I went to the lab to experience MRE. It is an experience like no other, and I do mean that in a good way. No needles, no poking and prodding, just a small circular device (much like the surface of a drum) that was strapped around my abdomen before I was moved into the MRI machine. Once in the machine, I was asked to inhale, exhale and then hold my breath. The 'drum' literally vibrated in different drum beats which then helped the physician see a better scan of my liver. It was pretty amazing."
MR Elastography is able to overcome many confounding factors that can impact the performance in other non-invasive technologies. Notably for fatty liver disease, this most often includes patients battling obesity or that may have Diabetes mellitus.
In these and other cases, clinical guidelines recommend that MRE, not transient elastography (i.e., Fibroscan®) to reliably estimate the degree of fibrosis present. Clinicians and patients may also request fat fraction measurements (steatosis), inflammation, and/or malignancy via traditional MR workup, resulting in a powerful and one-stop liver assessment.
MR Elastography (MRE) measures stiffness by assessing four images across the entire liver, resulting in a comprehensive and incredibly accurate diagnosis not available with other non-invasive technologies. In addition to a stiffness score measured in kPa, clinicians and patients often receive color-coded maps of their liver fibrosis, called Elastograms. In these intuitive maps, red corresponds to highly advanced fibrosis, while purple represents healthy liver tissue.
When to ask for MRE
MR Elastography is able to overcome many confounding factors that can impact the performance in other non-invasive technologies (left). Notably for fatty liver disease, this most often includes patients battling obesity and/or Diabetes mellitus, as ultrasound-based elastography methods often perform poorly in these patient groups.
Because MRE is not affected by waist circumference or obesity, clinical guidelines suggest MRE, instead of transient elastography (i.e., Fibroscan®), to reliably estimate the degree of fibrosis present. Clinicians and patients may also request fat fraction measurements (for steatosis), inflammation, and/or malignancy via traditional MR workup, resulting in a powerful, one-stop liver assessment.
The image here shows a typical MRI scan of the liver. While MRI is incredibly powerful at seeing anatomy, function, etc., traditional MRI hasn't yet been able to reliably distinguish between healthy tissue and stiffer tissue, such as fibrosis or cirrhosis.
"MRE and what it does, makes me think of a marshmallow. Just like a marshmallow fresh out of the bag, a soft liver is good. As a marshmallow gets stale, the surface hardens.
I was happy to learn that my liver is soft and healthy - and to find that out without experiencing any pain."
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