MRE Update

[mike716]

MRE Update

Hi, medhelpers! I had my MRE (magnetic resonance elastography) on Wednesday. This is an update.

This was part of a research project at the Radiology Department of Mt. Sinai Hospital in New York City. The project director is Dr. Bacir Taouli, and the coordinator is Claudia Donnerhack.

The study was done late in the evening, as the MRI machine is in normal use during the day. I was inside the machine for a total of one hour and twentry-five minutes. Quite an ordeal.

The first part, begun after I had fasted for six hours, consisted of a standard MRI of the abdomen. My entire body was inserted into the confines of the MRI tube with various apparatuses strapped to my chest and stomach, including two circular low-frequency sound transducers (one for the liver, one for the spleen) that transmit vibrations to the abdomen. This first scan took 45 minutes, during which I received instructions via headphones to alternately inhale, exhale, and hold my breath. Breathing affects the liver, so it's important to follow the instructions precisely.

The second part of the test was the elastography, and took around twenty minutes. The transducers were energized and my abdomen (and liver) were vibrated at 60 cycles/minute. Two takes each of four "slices" were done by the operator sliding me along the MRI chamber in brief increments. Then the same was done with my spleen.

When that part of the test was done, I was slid out of the MRI chamber and given two bottles of a liquid nutrient to drink. Then the second part of the test, the elastography, was repeated.

Everyone was very nice to me. They even paid me $80, which covered the cost of a taxi home. An anecdotal coincidence was that the test operator turned out to be from Buenos Aires!

I have been promised a CD with all the images (elastograms plus MRI). Meanwhile, I received an email report of Dr. Taouli's analysis of the test which I reproduce in the follow-up post below.

[mike716]

(Follow-up)

===================================================
MRI of the abdomen without IV contrast

Indication: Research fibrosis protocol.

Comparison: None

Technique: Fibrosis research protocol was utilized including axial
and coronal T2-weighted sequences, axial T2 star, elastography
sequences of the liver and spleen as well as axial DWI IVIM. The
patient was consented prior to the examination.

Contrast: None.

Findings:
The liver is noncirrhotic. No steatosis or iron deposition. No
definite liver mass within the limitation of noncontrast technique.
Cholelithiasis. No biliary dilatation. There is mildly increased
liver stiffness (3.65 kPa, normal less than 2.93), consistent with
stage F1.

The spleen is normal in size. There is no ascites or lymphadenopathy.
The pancreas and adrenal glands are normal. The kidneys are normal
with the exception of a 3.9 cm left renal cyst.

Impression:
Liver fibrosis, with mildly increased liver stiffness at 3.6 kPa
consistent with stage F1. Cholelithiasis.

Elastography data was interpreted based on the following study: Yin M
et al, Assessment of Hepatic Fibrosis With Magnetic Resonance
Elastography. Clinical Gastroenterology and Hepatology Volume 5, 2007
1207-1213.
The study was performed for research purposes, using investigational
device.
====================================================

My comment: Without having seen the elastogram yet, I believe the conclusion of F1 is a mean value. These mean values of elastograms have limited interest, since parts of the liver can still be F3 or F4. That, at least, has been my experience with the three Fibroscans I've had done. I'll have to wait for the elastograms on the CD to see the real situation. I'll post them here when  am able.

I hope my experience with MRE is of interest to the forum.

Cheers!

Mike

[Dannyboi7]

Very interesting,it's looking good for you.

[ceanothus]

Thank you for posting - this is very interesting to hear about the experience itself.

[Bali05]

Hey Mike,
This is fantastic news !
I am very very happy for you and thanks for sharing.

b

[Idyllic]

F1?

This is great Mike.•☀¸.•*´★¸¸.•*¨*•*♦¸
And somewhat close to the biopsy you had in 2008 (F1/F2) and on the money with the Fibroscan in 2009 (F1) but way off that other Fibroscan that indicated F3/F4 (never go to that place again). Ditto to all those tests that gave you the F0 & F4!!! This goes to show the variance there can be with different methods, operators and report interpretations.

I hope you feel a degree of confidence that enables you to make plans you feel comfortable with.

★★ $80 for a cab (?!) Well that is better than the wadded & crumpled dollar bill I received for my participation in the Fibroscan study (along with the stack of forms the size of a city phone book I had to fill out).

I am real happy for you and I hope you are too. Thanks for sharing this detailed account of your adventure ☺

[mike716]

Thank you all for your support and good wishes,

I'm of course delighted that Dr. Taouli thinks my liver is F1. However, I'm reserving judgment until I see the elastograms. I frankly cannot believe that the two Fibroscans that gave some readings of F3/F4 were in error. I think there must be parts of my liver that are, or were, at those fibrosis stages. It's the only thing that explains all the data, including the 2009 FibroTC (in my photos).

But who knows? All these tests leave something to be desired.

Also, isn't it possible that, just like transaminase levels in the blood, the fibrosis increases and decreases in cycles? After all, the liver can regenerate hepatocyte tissue. Could it be that when the immune system is especially strong it clears out the advanced-stage fibrosis?

MRE is a step in the right direction, but I don't think it's the last word.

Stay tuned for the MRE elastograms, which I will post when I have the CD.

Cheers!

Mike

[BigDaddy_59]

F1, cooooooolllll!
There is a lot going on in liver imaging and here is a post that Hector did about the AASLD's LiverLearning site and how to register for it and below that info on the presentation "Emerging Trends in Liver Imaging" on their site.

To access the AASLD materials from the latest Liver Meeting, when it becomes available, go to the following link.

http://liverlearning.aasld.org/aasld/events/

"Liver Learning" Register. Then search for what you are looking for.

"The Official E-learning Portal of AASLD.” Liver Learning compiles all of AASLD's online educational material in a streamlined, searchable format. You'll be able to find what you need, anytime you need it.

First, we unveil the latest from The Liver Meeting® 2011--ePosters, abstracts, State-of-the-Art Lectures, and numerous other talks and sessions. But the portal will also extend far beyond this year's meeting. Podcasts, slide sets and captured content from other AASLD meetings will be available, as well as our practice guidelines.
We designed Liver Learning to be intuitive and customizable. That's means you'll be able to search, filter, and organize content to suit your own preferences."

[BigDaddy_59]

Sorry, but due to MH's limit on lengths of post, I had to split it in two...
Chris

Dear Members and Colleagues,

AASLD is pleased to announce the availability of the first presentations from the AASLD Emerging Trends In Liver Imaging Conference on LiverLearning®: The Official eLearning Portal of AASLD.

You have the privilege of viewing these expert talks from your home, office or even while traveling! Below, you will find the easy steps to access the oral presentations published on the LiverLearning® Portal.

Ask the Panel: We invite you to ask questions to the Panel while viewing presentations from the Emerging Trends Conference. Simply look for the "Ask the forum" icon found on the side of the slide and ask your question!

To access presentations through "TALKS on the GO", please visit www.talksonthego.com or download it through the Apple App Store or Google Play store for Android Smartphones and Tablets by searching for: "Talks on the Go" (Please note you must include the quotation marks)

[mike716]

Hi, Chris.

Thanks for the AASLD info.

M.

[Bali05]

Mike wrote:
"Also, isn't it possible that, just like transaminase levels in the blood, the fibrosis increases and decreases in cycles? After all, the liver can regenerate hepatocyte tissue. Could it be that when the immune system is especially strong it clears out the advanced-stage fibrosis? "

Would be nice but I do not believe this is possible.Everywhere else in the body where scar tissue is formed it is for the most part there to stay.
The reason is propably that scar tissue is essentially dead cells
that are cut of from the blood stream and therefore hard to reach (dead).
The liver being very resilient is an organ that can regrow so it can
grow new cells around the scar tissue and thereby overall
become softer again and of course function better.
I also believe that since the Fibroscan or elatography readings only
read elasticity it is still questionable in how far a stiffness reading
actually and individually correlates to real scarring or fibrosis and not some other external factor. The good news I thinlk is that if the elasticity readings
error in their correlation to actual fibrosis it is on the high end
meaning that if you get a softer reading it is bound to be that way.
This is why FibroScan is mostly used to exclude cirrhosis and if you
do get higher readings a biopsy will be recommended to look at
actual cells. Of course the biopsy can have a  sampling error since
it only looks at a very tiny part of the organ.
If I were to dream up a procedure to most acurately get a fibrosis
screening it would consist of combination MRE and biopsy.
The MRE gives you a picture (like a weather map) of the entire
liver with varying degrees of elasticity. I would than go head and
biopsy the stiffest and the softest part from that map and look
at the cells under the microscope.

Just my thoughts.....

Cheers
b

[BoceprevirGal]

  Wow, that does sound like quite the ordeal.  I also agree with you,that this science is not exact.
   I had a FibroSure Test (which is a Special Chemistry Panel blood test,  that bases it's imfo on blood values, etc) which had me as cirrhotic, so I had a biopsy,which showed me as Stage 2, with grade 3 imflamation. Since my platelets had started slipping, from the borderline (150,000) in both feb and july of 2011, to 120,000 on oct and dec of 2011, I kind of saw myself as a personin the stage of heading towards cirrhosis.

[katla]

Very interestingindeed.

I've had a biopsy, Fibroscan, Fibrotest and APRI test and they all yielded different results ranging from F1-F4. The Fibroscan showed the highest/worst result.

[mike716]

The problem is, B., how do you get the biopsy needle to go into the parts of the liver that the MRE shows to be stiffest and softest?

The fact is that a liver biopsy is done from between the side of the ribs and only goes into one specific part of the liver: that nearest the ribs. There's no way to put the needle where you want to test the liver.

I agree that liver stiffness (elastography) is not an unquestionable correlative to fibrosis. It's an indirect measure, like all the other tests except biopsy. And judging by the three Fibroscans I've had, it can be mistaken. Very mistaken. That's why I take the F1 report with a big grain of salt.

I received the CDs today, but I don't have a CD reader with my netbook computer. Tomorrow I'll go around the neighborhood and see if I can find a computer shop that will let me use theirs, or else buy one. Then, if the elastograms are legible, I'll post them in the photo section of my Medhelp homepage.

Cheers.

Mike

[mike716]

Not to be too negative, I tend to trust Fibrosure more than a biopsy, but that's just my personal prejudice. Blood panels have the advantage of not testing just one part of the liver.

On the other hand, the biopsy proves that at least some part of your liver is still at F2. Maybe a large part.

Regarding fibrosis progression, there's more controversy surrounding that issue than there is surrounding the tests of current fibrosis stage. I have a collection of over twenty articles on progression, many of them contradicting the others. When I had a biopsy in 2008 showing F1/F2 and a year later a Fibroscan showing F3/F4, I got heated up on the subject. I found a large French statistical study of over a thousand HCV patients that charts progression against a number of variables, and exchanged emails with the author, who assured me that no one goes from F1/F2 to F3/F4 in one year. But who knows? There was someeone in this forum whose biopsy showed F1, and three years later he had declared, uncompensated cirrhosis. It's all madness.

[mike716]

Hi, Katia.

Your experience is similar to mine. With so many contradictory test results, you don't know what to think. The more tests I get, the more confused and upset I am. I was hoping that this MRE might solve the riddle. But that result of F1 has got to be wrong. Even my biopsy showed F1/F2, and the Fibroscans up to F4.

What a can of worms!

M.

[Bali05]

"What a can of worms!" ....indeed.
Talking about Fibrosure bloodmarker test in my case over a period
of 7 months my FibroScan went from F2 to F1-F0 and my Fibrosure
from F2 to F3. I did not believe the F3 since my FibroScan was F0-F1
so I repeated the Fibrosure only 1 week later. Came back full scale F4.
So I went from F3 to F4 in 1 week ......lol

b

[mike716]

I promised to post the results of the MRE, and if I haven't done so it's because I haven't received the liver elastogram that was promised me. I don't know what the problem is with the doctor who's directing the trial. He sent me two CDs full of MRI images, but no liver elastogram. I'm not happy, as you can imagine, after spending over an hour and a half inside an MRI tube, which is no fun.

I still have hopes of getting the elastogram by putting some pressure on the MD who referred me. If and when I do get it, I'll post it here in my photos, as I said I would.

I hate to think that I was lured into a trial with false promises, but it's certainly starting to look that way. Why is it that you just can't trust doctors? Horrible, really.

Cheers!

Mike

[Dannyboi7]

  Sorry to hear you didn't get those results in yet.I was anticipating to see all the outcomes of tests would be.Maybe you will get them in the near future,one things for sure they owe you a rational explanation why they are not giving you the results.

[Bali05]

Hey Mike,
was thinking about you .I will be up there to do another  followup FibroScan
next week.
Do you think they still take people for this MRE trial ?
The only way that they are not releasing all your data is if you
signed something to that regard. Because it being a trial they
can possibly have claim of ownership on the information I could
imagine but only if you let them have it by signing a waiver.

b

[Dannyboi7]

If you correlate your fibroscan results with your APRI INDEX and FIB4 SCORE,it will give you pretty good idea on how much liver  damage you have.

[Bali05]

Today (approx. 1.5 years post tx) my APRI is 0.236 and FIB-4 is 1.02
FibroScan at baseline before tx 5.9 kPa , 5.9 kPa wk12, 7.0 kPa wk48 and 7.5 kPa six months after tx.

[Dannyboi7]

Looks like you got around the same numbers as me with the non invasive scoring methods.As you probably know doing fibroscans during treatment and up to 6 months post treatment is not very conclusive since the meds makes your lliver a little stiffer and inflamed .Same with APPRI and FIB4.It's better to wait at least one year after treatment to do it.In any case it's fun to play with the numbers during that time,they can be all over the place and out whack.You're 1.5 year post treatment,this a great time to do it.I'l bet you the numbers will be lower than baseline.

BTW congrats on being cured.

[Bali05]

Actually my Fib-4 was also lower at baseline before tx  0.74 vs. 1.02 today1.5 years post.

"during treatment and up to 6 months post treatment is not very conclusive since the meds makes your lliver a little stiffer and inflamed "

That was the argument of the Drs. when my FibroScan went up during tx
and it sounds good doesn`t it ?

The problem I have with that is that  I took ALTs same day I did Fibroscans
and it coincedentally was highest (75) on the day I got my lowest FibroScan
which was 5.9 kPa at baseline  At SVR my FS was 7.5 kPa and ALT 28.
So if ALT is an indicator for inflammation the higher FibroScan readings
@ wk48 and after tx can not be blamed on higher inflammation.



b

[mike716]

Hi, Danny. Thank you for your commiseration. It looks like I was lied to just to get me into the trial. Either they never intended to produce the liver elastogram from the data, or it´s too much trouble for them to do so. Bottom line: the patient/volunteer is unworthy of any respect.

I should have learned by now not to trust doctors, but I must admit I was fooled.

I´m going to appeal to the referring MD and then make a stink at the hospital where the trial is being done. But they probably figure that since I´m back in Argentina there isn´t much I can do.

C'est la vie.

Mike