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The objective of this study was to investigate the image quality and diagnostic performance of model-based iterative reconstruction (MBIR) for hepatic vessel evaluation on low-tube-voltage (100 kilovolt [peak]) liver computed tomography (CT) for living donors.Fifty-one liver donor candidates (low-kilovolt group) underwent low-tube-voltage CT, which was reconstructed using filtered back projection, adaptive statistical iterative reconstruction, and MBIR. Additional 51 donor candidates who underwent 120-kilovolt (peak) CT using FBP were selected as matching control (standard group). The volume CT dose index, image noise, contrast-to-noise ratios, diagnostic accuracy, and confidence of hepatic vasculatures were evaluated.Significant dose reduction was obtained with low-tube-voltage CT. The MBIR images of the low-kilovolt group showed significantly lower image noise and higher contrast-to-noise ratios than did the other image sets (P0.001). Regarding diagnostic accuracy and confidence of hepatic vessel anatomic variations with surgical correlation, the MBIR images provided results equivalent to those of other images (P0.05).Low-tube-voltage liver CT using MBIR may increase image quality and preserve diagnostic performance of hepatic vessel evaluation at reduced radiation dose.

To determine the incremental value of small field of view (sFOV) high-resolution (HR) gadoxetic acid-enhanced 3D TIn all, 73 living donor candidates underwent gadoxetic acid-enhanced MRI (3.0T) including three kinds of MRCs: 3D multislice TCompared to TThe combination of sFOV HR-T3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:152-159.

Magnetic resonance imaging (MRI) plays an important role in abdominal imaging. The high contrast resolution offered by MRI provides better lesion detection and its capacity to provide multiparametric images facilitates lesion characterization more effectively than computed tomography. However, the relatively long acquisition time of MRI often detrimentally affects the image quality and limits its accessibility. Recent developments have addressed these drawbacks. Specifically, multiphasic acquisition of contrast-enhanced MRI, free-breathing dynamic MRI using compressed sensing technique, simultaneous multi-slice acquisition for diffusion-weighted imaging, and breath-hold three-dimensional magnetic resonance cholangiopancreatography are recent notable advances in this field. This review explores the aforementioned state-of-the-art techniques by focusing on their clinical applications and potential benefits, as well as their likely future direction.

Objective To compare a high acceleration three-dimensional (3D) T1-weighted gradient-recalled-echo (GRE) sequence using the combined compressed sensing (CS)-sensitivity encoding (SENSE) method with a conventional 3D GRE sequence using SENSE, with respect to image quality and detectability of solid focal liver lesions (FLLs) in the hepatobiliary phase (HBP) of gadoxetic acid-enhanced liver MRI. Materials and Methods A total of 217 patients with gadoxetic acid-enhanced liver MRI at 3T (54 in the preliminary study and 163 in the main study) were retrospectively included. In the main study, HBP imaging was done twice using the standard mDixon-3D-GRE technique with SENSE (acceleration factor [AF]: 2.8, standard mDixon-GRE) and the high acceleration mDixon-3D GRE technique using the combined CS-SENSE technique (CS-SENSE mDixon-GRE). Two abdominal radiologists assessed the two MRI data sets for image quality in consensus. Three other abdominal radiologists independently assessed the diagnostic performance of each data set and its ability to detect solid FLLs in 117 patients with 193 solid nodules and compared them using jackknife alternative free-response receiver operating characteristics (JAFROC). Results There was no significant difference in the overall image quality. CS-SENSE mDixon-GRE showed higher image noise, but lesser motion artifact levels compared with the standard mDixon-GRE (all p < 0.05). In terms of lesion detection, reader-averaged figures-of-merit estimated with JAFROC was 0.918 for standard mDixon-GRE, and 0.953 for CS-SENSE mDixon-GRE (p = 0.142). The non-inferiority of CS-SENSE mDixon-GRE over standard mDixon-GRE was confirmed (difference: 0.064 [−0.012, 0.081]). Conclusion The CS-SENSE mDixon-GRE HBP sequence provided comparable overall image quality and non-inferior solid FFL detectability compared with the standard mDixon-GRE sequence, with reduced acquisition time.

Purpose To determine the value of adding diffusion-weighted imaging (DWI) to conventional magnetic resonance cholangiopancreatography (MRCP) for differentiating benign from malignant distal biliary strictures. Materials and Methods Two independent readers reviewed three image sets (1: MRCP alone; 2: MRCP and DWI combined; and 3: MRCP, DWI, and contrast-enhanced T1-weighted imaging [T1WI] combined) of 60 patients with suspected distal biliary strictures and rated the probability of malignancy. Diagnostic performance and accuracy were compared using the receiver operating characteristic (ROC) curves and McNemar two-tailed test. κ coefficients were calculated to assess the interobserver agreement. Results The Az value and accuracy improved significantly after additional review of DWI for both readers: Az = 0.780 vs. 0.916 (P = 0.003) for Reader 1 and 0.784 vs. 0.853 (P = 0.037) for Reader 2; accuracy = 69% vs. 93% for Reader 1 (P 0.050). There was substantial interobserver agreement in all three image sets (κ = 0.695-0.732). Conclusion The addition of DWI to MRCP significantly improved diagnostic accuracy in the characterization of distal biliary strictures. J. Magn. Reson. Imaging 2014;39:1509–1517. © 2013 Wiley Periodicals, Inc.

To retrospectively evaluate concordance rates and predictive values in concordant cases among multiparametric MR techniques and FDG-PET to grade cerebral gliomas. Multiparametric MR imaging and FDG-PET were performed in 60 consecutive patients with cerebral gliomas (12 low-grade and 48 high-grade gliomas). As the dichotomic variables, conventional MRI, minimum apparent diffusion coefficient in diffusion-weighted imaging, maximum relative cerebral blood volume ratio in perfusion-weighted imaging, choline/creatine ratio and (lipid and lactate)/creatine ratio in MR spectroscopy, and maximum standardised uptake value ratio in FDG-PET in low- and high-grade gliomas were compared. Their concordance rates and positive/negative predictive values (PPV/NPV) in concordant cases were obtained for the various combinations of multiparametric MR techniques and FDG-PET. There were significant differences between low- and high-grade gliomas in all techniques. Combinations of two, three, four, and five out of the five techniques showed concordance rates of 77.0 ± 4.8 %, 65.5 ± 4.0 %, 58.3 ± 2.6 % and 53.3 %, PPV in high-grade concordant cases of 97.3 ± 1.7 %, 99.1 ± 1.4 %, 100.0 ± 0 % and 100.0 % and NPV in low-grade concordant cases of 70.2 ± 7.5 %, 78.0 ± 6.0 %, 80.3 ± 3.4 % and 80.0 %, respectively. Multiparametric MR techniques and FDG-PET have a concordant tendency in a two-tiered classification for the grading of cerebral glioma. If at least two examinations concordantly indicated high-grade gliomas, the PPV was about 95 %. • Modern imaging techniques can help predict the aggressiveness of cerebral gliomas. • Multiparametric MRI and FDG-PET have a concordant tendency to grade cerebral gliomas. • Their high-grade concordant cases revealed at least 95 % positive predictive values. • Their low-grade concordant cases revealed about 70–80 % negative predictive values.

To prospectively assess the safety and mid-term therapeutic effectiveness of monopolar radiofrequency (RF) ablation with a multiple-electrode switching system for treating small- and medium-sized (≤ 5 cm) hepatocellular carcinomas (HCCs).The institutional review board approved this prospective study, and all patients gave informed consent. From February 2009 to January 2010, 166 patients (110 men and 56 women; age range, 38-86 years; mean age, 62 years ± 10 [standard deviation]) with 166 HCCs less than or equal to 5 cm in diameter were treated with monopolar RF ablation with a multiple-electrode switching system. One of three experienced radiologists performed the RF ablation. Technique effectiveness, ablation volume and time, and major complications were evaluated by means of computed tomography (CT) immediately after RF ablation and at follow-up CT examinations at 1 month and then every 3 months after the procedure. The overall survival, disease-free survival, and local tumor progression-free survival rates were evaluated by using the Kaplan-Meier method.The technique effectiveness rate determined 1 month after RF ablation was 99.4%. Mean ablation parameters were as follows: volume, 85 cm(3) ± 54; maximum diameter, 61 mm ± 13; and minimum diameter, 43 mm ± 11. The major complication rate was 4.8%. The 6-month and 1-, 2-, and 3-year local tumor progression rates were 2%, 6%, 10%, and 11%, respectively. The overall survival rates at 1, 2, and 3 years after RF ablation were 99%, 97%, and 96%, and corresponding local tumor progression-free survival rates were 94%, 90%, and 89%, respectively. The disease-free survival rates at 1, 2, and 3 years after RF ablation were 75%, 60%, and 54%, respectively.Monopolar RF ablation with a multiple-electrode switching system in small- and medium-sized HCCs was safe and efficient, and it provided successful local tumor control and high local tumor progression-free survival rates because an adequate ablation volume was obtained.

OBJECTIVES The objective of this study was to compare the diagnostic performance of magnetic resonance elastography (MRE) and gadoxetate disodium-enhanced magnetic resonance imaging (MRI) in the staging of hepatic fibrosis (HF) in patients with liver diseases. MATERIALS AND METHODS This retrospective study was approved by our institutional review board, and the informed consent was waived. One hundred and sixty-eight patients with chronic liver disease or suspected focal hepatic lesions underwent MRE and gadoxetate disodium-enhanced MRI at 1.5 T. Liver stiffness values were measured on quantitative shear-stiffness maps. The contrast enhancement index (CEI) was calculated as SIpost / SIpre, where SIpost and SIpre are, respectively, the liver-to-muscle signal intensity (SI) ratio on hepatobiliary phase images and on unenhanced images. The diagnostic performance of MRE and CEI for staging HF was compared using the receiver operating characteristic curve analysis on the basis of the histopathologic analysis of HF. RESULTS The liver stiffness values measured on MRE (r = 0.802; P < 0.0001) were more strongly correlated with the HF stage than with the CEI (r = -0.378; P < 0.0001). The areas under the receiver operating characteristic curve values of the liver stiffness values were significantly larger than those of CEI were for discriminating all stages of HF (P < 0.001 for ≥ F1, ≥ F2, ≥ F3, and ≥ F4). Magnetic resonance elastography showed higher sensitivity and specificity for predicting HF ≥ F1 (91% and 87%), ≥ F2 (87% and 91%), ≥ F3 (80% and 89%), and F4 (81% and 85%) compared with CEI (46% and 85%, 46% and 82%, 63% and 68%, and 76% and 65%, respectively). CONCLUSIONS Magnetic resonance elastography was superior to the gadoxetate disodium-enhancement MRI for HF staging.

The purpose of this study was to compare image quality and lesion detectability in the evaluation of hypervascular hepatocellular carcinoma (HCC) on low-tube-voltage half-dose liver CT scans subjected to sinogram-affirmed iterative reconstruction (SAFIRE) with the quality and detectability on full-dose scans reconstructed with filtered back projection (FBP).A total of 126 patients with suspected HCC who underwent liver CT including arterial phase scanning at 80 kVp in the dual-source mode (300 mAs for each tube) were included in the study. The half-dose arterial scans were reconstructed with FBP, iterative reconstruction in image space (IRIS), and five SAFIRE strengths (S1-S5) and were compared with full-dose virtual scans (600 mA) reconstructed with FBP. We assessed image noise, contrast-to-noise ratio (CNR) of the liver and blood vessels, and lesionto-liver CNR. Two radiologists evaluated image quality and lesion detectability attained with the different imaging sets.Image noise on SAFIRE images was significantly lower than that on the other images, and the CNRs on SAFIRE images were higher than those on half-dose FBP images (p0.001). In addition, lesion-to-liver CNR on the half-dose S5 SAFIRE images was higher than on IRIS and full-dose FBP images (p0.05). Among the half-dose scans, SAFIRE images had significantly better image quality than FBP images (p0.05). Regarding lesion detection, half-dose SAFIRE images were better than half-dose FBP images and were comparable with full-dose FBP images (observer 1, 91.8% vs 96%; observer 2, 98% vs 98%; p0.05).Performing half-dose 80-kVp liver CT with SAFIRE technique may increase image quality and afford comparable lesion detectability of hypervascular HCC at a reduced radiation dose compared with full-dose CT with FBP.

To investigate the patterns of imaging appearance of hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced magnetic resonance (MR) images and to assess their potential value as prognostic markers of HCC associated with tumor recurrence after surgery.The institutional review board approved this retrospective study and informed consent was waived. A total of 216 patients with 304 pathologically proved HCCs underwent gadoxetic acid-enhanced MR imaging prior to surgery and were included in the study. Two reviewers, blinded to the clinical data, evaluated in consensus the imaging patterns of HCC according to enhancement patterns on dynamic phase images and signal intensity on hepatobiliary phase (HBP) images. The association of imaging features with clinical-pathologic findings was evaluated by using the Student t test, χ(2) test, Mann-Whitney U test, and linear-by-linear association. The dependence of time to tumor recurrence (TTR) after surgery was evaluated by using the Kaplan-Meier method, log-rank test, and Cox proportional hazard model.HCCs with atypical enhancement pattern (P = .0167, P = .0450, P.0001, respectively) and iso- to hyperintensity on HBP images (P = .0001, P = .0002, P.0001, respectively) had smaller tumor size, lower histologic grade, and worse Child-Pugh class. The log-rank test (P = .0064) and Cox proportional hazards model (hazard ratio, 5.676; P = .0158) revealed that HCCs with iso- to hyperintensity on HBP images had significantly longer TTR than HCCs with hypointensity on HBP images.HCCs can be classified into several imaging patterns on gadoxetic acid-enhanced MR images, which are associated with tumor aggressiveness and outcome. In addition, iso- to hyperintensity on HBP images may be a useful imaging biomarker to indicate longer TTR after surgery. .

Purpose To determine whether parameters obtained from intravoxel incoherent motion (IVIM)-diffusion-weighted imaging (DWI) using multiple b-values can improve characterization of common focal liver lesions (FLLs), compared with the apparent diffusion coefficient (ADCtotal). Materials and Methods Our Institutional Review Board approved this retrospective study and informed consent was waived. In all, 142 patients with 169 FLLs underwent liver magnetic resonance imaging (MRI) including IVIM-DWI with multiple b factors at 3.0T. ADCtotal and IVIM-DWI-derived parameters including true diffusion (Dt), pseudodiffusion (Dp), and perfusion fraction (f) were calculated for each lesion and compared using dedicated software. Results Dt and ADCtotal were significantly lower in malignancies (0.95 ± 0.21, 1.14 ± 0.24, (×10−3 mm2/sec)) than in benign FLLs (1.61 ± 0.34, 1.72 ± 0.37, (×10−3 mm2/sec)). In the differential diagnosis of malignancies from benign lesions, Dt (Az value: 0.971) showed better diagnostic performance than ADCtotal (Az: 0.933) (P

Purpose To determine the reproducibility of MR elastography (MRE) and the reproducibility and repeatability of the stiffness measurement of MRE in the staging of liver fibrosis. Materials and Methods Ninety-four patients, who underwent liver MRE, were included in this study. The patients were classified into group 1 (n = 47) and group 2 (n = 47) according to our knowledge of their histologic hepatic fibrosis (HF) stage. To analyze the reproducibility of MRE, the group 1 patients underwent MRE twice. In addition, to evaluate the repeatability and reproducibility of the stiffness measurement of MRE, a single observer measured the stiffness values of the second MREs in group 1 twice, and two observers independently measured the stiffness values of MRE in group 2. A 95% Bland-Altman limits of agreement and intraclass correlation coefficients (ICCs) were used to evaluate the reproducibility and repeatability of MRE. Results In group I, there was no significant difference in the mean liver stiffness values of the first and second MRE examinations, i.e., 3.45 ± 0.25 kPa vs. 3.35 ± 0.23 kPa (p = 0.22). The reproducibility of the MRE examination and the reproducibility and repeatability of the stiffness measurement were high, i.e., the ICCs of each parameter were 0.945, 0.827, and 0.963, respectively, and the 95% limits of agreement were 25.3%, 35.35%, and 18.0%, respectively. Conclusion MRE is a promising tool for evaluating HF and has high reproducibility of the examination as well as reproducibility and repeatability of the stiffness measurements. J. Magn. Reson. Imaging 2014;39:326–331. © 2013 Wiley Periodicals, Inc.

Purpose To determine whether a controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA) technique can improve the image quality of three-dimensional (3D), T1-weighted gradient echo (T1w-GRE) imaging compared with the use of a standard, parallel acquisition technique (PAT). Materials and Methods Sixty-four patients who underwent liver MR on a 3 Tesla (T) scanner, were included in this study. Twenty minutes after the injection of 0.025 mmole/kg of gadoxetic acid, 3D T1w-GRE imaging (volumetric interpolated breathhold examination [VIBE]) was acquired twice using a generalized autocalibrating partially parallel acquisition (384 × 250 matrix, acceleration factor [AF] of 2) and a CAIPIRINHA (384 × 380 matrix, AF of 4), respectively. Qualitative image analysis was performed for two image sets. Results CAIPIRINHA-VIBE showed better hepatic vessel clarity and lesion conspicuity than standard VIBE (P < 0.05). CAIPIRINHA-VIBE in the coronal plane also provided better results of motion artifact and liver edge sharpness than the standard VIBE (P < 0.05). Despite the more apparent PAT artifact on CAIPIRINHA-VIBE than on standard VIBE (P < 0.05), CAIPIRINHA-VIBE showed better overall image quality. Conclusion The CAIPIRINHA-VIBE was able to provide a higher spatial resolution, T1-weighted imaging with better image quality compared with a standard VIBE. J. Magn. Reson. Imaging 2013;38:1020–1026. © 2013 Wiley Periodicals, Inc.

To investigate the added value of diffusion-weighted imaging (DWI) to magnetic resonance cholangiopancreatography (MRCP) with unenhanced MR imaging for predicting the malignancy or invasiveness of intraductal papillary mucinous neoplasms (IPMNs).Following Institutional Review Board (IRB) approval, this retrospective study included 52 patients with surgically resected IPMNs and who underwent MRCP, unenhanced MRI, and DWI. Three blinded radiologists evaluated the two image sets, ie, MRCP with unenhanced MR images vs. the combined set with MRCP, unenhanced MR images, and DWI, and scored their confidence for malignancy or for invasiveness of IPMNs. The mean apparent diffusion coefficient (ADC) values of benign IPMNs and of intraductal mucinous carcinomas (IPMCs) were compared. The diagnostic accuracy was calculated using receiver operating characteristic (ROC) curve analysis.The mean ADC of malignant IPMNs (2.05 ± 0.66 × 10(-3) mm(2) /sec) was significantly lower than that of benign IPMNs (2.95 ± 0.32 × 10(-3) mm(2) /sec, P0.0001). Invasive IPMCs (1.51 ± 0.32 × 10(-3) mm(2) /sec) showed significantly lower ADC than that of noninvasive IPMCs (2.67 ± 0.23 × 10(-3) mm(2) /sec, P = 0.0003). The area of diffusion restriction was more frequently seen in malignant IPMNs than in benign IPMNs (P0.00001). The addition of DWI to MRCP with unenhanced MRI did not show a significant improvement for predicting malignant IPMN (P0.05), but resulted in a tendency to improve the diagnostic accuracy for the prediction of invasive IPMN in two observers (P = 0.072, P = 0.085).The addition of DWI to MRCP with unenhanced MRI may improve the diagnosis of malignant IPMN and further increase the prediction of invasive IPMC.

Purpose To assess the diagnostic accuracy of gadoxetic acid-enhanced biliary MRI with MR cholangiography (MRC) in the preoperative evaluation of bile duct cancer (BDC) staging and resectability. Materials and Methods Seventy-three patients with BDC who underwent gadoxetic acid-enhanced biliary MRI and MRC, were included in this study. Two abdominal radiologists evaluated the biliary MRI findings regarding the tumor extent, vascular involvement, lymph node metastasis, and tumor resectability. The results were compared with the surgical and pathology findings which were used as the standard reference. The diagnostic performance of the MRI was evaluated using receiver operating characteristics (ROC) analysis. In addition, to determine whether the hepatobiliary phase images had been successfully obtained, the enhancement percentage of the hepatic parenchyma was measured on the portal venous images (PVI) and hepatobiliary phase images (HBPI), respectively. Results The overall accuracy of the two reviewers for determining the tumor resectability was 61.6% and 83.5%, respectively. The Az values were 0.802 for reviewer 1 and 0.892 for reviewer 2 in the evaluation of the secondary biliary confluence tumor involvement and 0.773 for reviewer 1 and 0.846 for reviewer 2 in the evaluation of the intrapancreatic bile duct involvement. In the evaluation of the vascular involvement, the Az values were 0.718 and 0.906, respectively, for the hepatic artery evaluation and 0.55 and 0.88, respectively, for the portal vein evaluation. For assessment of lymph node metastasis, the overall accuracy was 69.6% and 79.7%, respectively. The mean enhancement percentages of hepatic parenchyma on PVI and HBPI were 39.3% and 65.9%, respectively (P % 0.05), and 49 of 73 patients (67.1%) showed higher enhancement percentage on HBPI than on PVI Conclusion Gadoxetic acid-enhanced MRI with MRC is a reliable diagnostic method for assessing the tumor extent and resectability of BDC. J. Magn. Reson. Imaging 2013;38:138–147. © 2013 Wiley Periodicals, Inc.

PURPOSE To determine the additional diagnostic value of high b-value diffusion-weighted imaging (DWI) compared to conventional biliary magnetic resonance imaging (MRI) for differentiating gallbladder (GB) cancer from benign GB diseases with wall thickening. MATERIALS AND METHODS Thirty-nine patients with GB cancers and 36 patients with cholecystitis having preoperative biliary MRIs were included. All patients underwent unenhanced T1- and T2-weighted imaging (T2WI), Gd-enhanced dynamic MRI, and DWI (b values 0, 100, 500, 1000 s/mm(2) ). Two radiologists independently analyzed two sets of MRI for characterization of GB lesions: a conventional biliary image (CBI) set with T1- and T2WI and a dynamic image; and a DWI set composed of DWI and a CBI set. Diagnostic accuracy and sensitivity were evaluated using the receiver operator characteristic method. The mean apparent diffusion coefficient (ADC) values of the lesions were also calculated. RESULTS The Az values were 0.856 and 0.960 for reviewers 1 and 2, respectively, with the CBI set and increased to 0.952 and 0.983 with the DWI set. The mean ADC value of GB carcinoma was 1.46 ± 0.45 × 10(-3) mm(2) /s and that of cholecysititis was 2.16 ± 0.56 × 10(-3) mm(2) /s (P < 0.0001). CONCLUSION Adding DWI to the standard biliary MRI protocol may improve sensitivity for distinguishing GB cancers from benign GB diseases with wall thickening.

Purpose To determine whether B

To describe the natural history of pancreatic cysts after long-term follow-up, with an emphasis on the identifying indicators of indolent lesions. We retrospectively sampled 95 patients with 149 cysts

OBJECTIVE To prospectively compare technical success rate and reliable measurements of virtual touch quantification (VTQ) elastography and elastography point quantification (ElastPQ), and to correlate liver stiffness (LS) measurements obtained by the two elastography techniques. MATERIALS AND METHODS Our study included 85 patients, 80 of whom were previously diagnosed with chronic liver disease. The technical success rate and reliable measurements of the two kinds of point shear wave elastography (pSWE) techniques were compared by χ(2) analysis. LS values measured using the two techniques were compared and correlated via Wilcoxon signed-rank test, Spearman correlation coefficient, and 95% Bland-Altman limit of agreement. The intraobserver reproducibility of ElastPQ was determined by 95% Bland-Altman limit of agreement and intraclass correlation coefficient (ICC). RESULTS The two pSWE techniques showed similar technical success rate (98.8% for VTQ vs. 95.3% for ElastPQ, p = 0.823) and reliable LS measurements (95.3% for VTQ vs. 90.6% for ElastPQ, p = 0.509). The mean LS measurements obtained by VTQ (1.71 ± 0.47 m/s) and ElastPQ (1.66 ± 0.41 m/s) were not significantly different (p = 0.209). The LS measurements obtained by the two techniques showed strong correlation (r = 0.820); in addition, the 95% limit of agreement of the two methods was 27.5% of the mean. Finally, the ICC of repeat ElastPQ measurements was 0.991. CONCLUSION Virtual touch quantification and ElastPQ showed similar technical success rate and reliable measurements, with strongly correlated LS measurements. However, the two methods are not interchangeable due to the large limit of agreement.

Purpose To evaluate the diagnostic performance of magnetic resonance (MR) elastography in staging liver fibrosis in patients with chronic hepatitis B (CHB) and other etiologic causes. Materials and Methods This retrospective study was institutional review board-approved and the requirement for informed consent was waived. Before surgery, MR elastographic imaging was performed in 352 patients with chronic liver diseases (281 patients with CHB, 71 patients without CHB) and hepatocellular carcinomas and 64 living liver donor candidates. Liver stiffness (LS) values were measured on quantitative shear-stiffness maps of MR elastography, and the diagnostic performance of MR elastography in staging liver fibrosis was evaluated by using receiver operating characteristic curve analysis and the Obuchowski measure with the histopathologic analysis of liver fibrosis in the CHB group and in the group composed of other etiologic causes. In 120 patients (97 with CHB, 23 without CHB) and 51 donors, diagnostic performance of MR elastography was validated. Results Areas under the curve of LS values for the diagnosis of significant fibrosis (≥stage F2), severe fibrosis (≥stage F3), and cirrhosis (stage F4) in the CHB group were 0.972 (95% confidence interval: 0.948, 0.987), 0.946 (95% confidence interval: 0.916, 0.968), and 0.920 (95% confidence interval: 0.885, 0.947), respectively. Obuchowski measures were similarly high in the CHB group and in the group composed of other etiologic causes (0.970 vs 0.977). However, the estimated cutoff value for stage F4 in the group with CHB was substantially lower than in the participants with other etiologic causes: 3.67 kPa versus 4.65 kPa. In the validation study for stage F1 or greater, stage F2 or greater, stage F3 or greater, and stage F4, the Youden indexes were 0.807, 0.842, 0.806, and 0.639, respectively, in the group with CHB, and 0.783, 0.900, 1.000, and 0.917, respectively, in the group without CHB. Conclusion The diagnostic performance of MR elastography in liver fibrosis staging was similarly high in the groups with and without CHB, but the cutoff LS values for diagnosing liver cirrhosis differed between the groups with and without CHB. (©) RSNA, 2016 Online supplemental material is available for this article.

Purpose To assess the diagnostic performance of gadoxetic acid-enhanced magnetic resonance (MR) imaging in the evaluation of portal vein thrombosis (PVT) in patients with hepatocellular carcinoma (HCC). Materials and Methods This retrospective study was approved by the institutional review board. The requirement to obtain informed consent was waived. A total of 366 patients with HCC who underwent gadoxetic acid-enhanced MR imaging between January 2007 and May 2013, including 134 with malignant PVT, 49 with benign PVT, and 183 without PVT matched for age and sex, comprised our study population. PVTs were complete in 125 patients and partial in 58 and were located in a major portal vein (n = 159) or segmental portal vein (n = 24). Two radiologists independently reviewed the MR images and assessed the sensitivity, specificity, and accuracy in the detection and characterization of PVT according to location (major vs segmental) and type (complete vs partial). The Fisher exact or χ(2) test was used to evaluate sensitivity difference between the subsets. Results Gadoxetic acid-enhanced MR imaging showed good sensitivity (reviewer 1, 84% [154 of 183 patients]; reviewer 2, 70% [129 of 183 patients]) and high specificity (reviewer 1, 89% [163 of 183 patients]; reviewer 2, 96% [176 of 183 patients]) in the detection of PVT. Diagnostic accuracy for differentiating malignant PVT from benign PVT was high (reviewer 1, 92% [141 of 154 patients]; reviewer 2, 95% [122 of 129 patients]). However, there was slightly lower sensitivity for detecting segmental PVT compared with that of major PVT in the malignant PVT group (reviewer 1, 95% [104 of 110 patients] vs 88% [21 of 24 patients]; reviewer 2, 82% [90 of 110 patients] vs 79% [19 of 24 patients]; P = .203 and .775 for reviewers 1 and 2, respectively). Conclusion Gadoxetic acid-enhanced MR imaging provided good diagnostic performance in the detection of PVT and the differentiation of malignant from benign PVT in patients with HCC. However, caution is needed when evaluating potential candidates for curative treatment because of the low sensitivity for segmental PVT in the malignant PVT group. (©) RSNA, 2016 Online supplemental material is available for this article.

Intensity inhomogeneity (bias field) is a common artefact in magnetic resonance (MR) images, which hinders successful automatic segmentation. In this work, a novel algorithm for simultaneous segmentation and bias field correction is presented. The proposed energy functional allows for explicit regularization of the bias field term, making the model more flexible, which is crucial in presence of strong inhomogeneities. An efficient minimization procedure, attempting to find the global minimum, is applied to the energy functional. The algorithm is evaluated qualitatively and quantitatively using a synthetic example and real MR images of different organs. Comparisons with several state-of-the-art methods demonstrate the superior performance of the proposed technique. Desirable results are obtained even for images with strong and complicated inhomogeneity fields and sparse tissue structures.

Objective This study was conducted to evaluate the outcomes of multi-channel switching RFA using a separable cluster electrode in patients with HCC. Methods From November 2011 to July 2013, 79 patients with 98 HCCs < 5 cm were enrolled and treated with RFA using a multi-channel switching radiofrequency system and a separable cluster electrode under the guidance of a real-time fusion imaging system. The primary and secondary endpoints were the 3-year local tumor progression (LTP) rate and recurrence-free survival (RFS) rate, respectively. For post hoc analyses, LTP, RFS, and major complication rates were retrospectively compared with a historical control group treated with RFA using the same radiofrequency system but with multiple internally-cooled electrodes. Results The technique success rate of the 98 tumors was 100%. Cumulative 1-year, 2-year, and 3-year LTP rates were 3.4%, 6.9%, and 12.4%, respectively. For patient-level data, cumulative 1-year, 2-year, and 3-year RFS rates were 83.9%, 68.6%, and 45.4%, respectively. On post hoc analyses, none of the baseline characteristics showed a significant difference between the separable cluster electrode and multiple internally-cooled electrodes group. Cumulative LTP and RFS rates of the two groups also showed no significant difference (p = 0.401 and p = 0.881, respectively). Finally, major complication rates of the separable cluster electrode group (5.0%, 4/79) and multiple internally-cooled electrodes group (5.9%, 4/74) were also comparable (p = 1.000). Conclusion Switching monopolar RFA using a separable cluster electrode is a feasible and efficient technique for the treatment of HCCs smaller than 5 cm, providing comparable local tumor control to multiple internally-cooled electrodes. Trial Registration ClinicalTrials.gov NCT02745483

With the recent dramatic advances in diagnostic modalities, the diagnosis of hepatocellular carcinoma (HCC) is primarily based on imaging. Ultrasound (US) plays a crucial role in HCC surveillance. Dynamic multiphasic multidetector-row CT (MDCT) and magnetic resonance imaging (MRI) are the standard diagnostic methods for the noninvasive diagnosis of HCC, which can be made based on hemodynamic features (arterial enhancement and delayed washout). The technical development of MDCT and MRI has made possible the fast scanning with better image quality and resolution, which enables an accurate CT hemodynamic evaluation of hepatocellular tumor, as well as the application of perfusion CT and MRI in clinical practice. Perfusion CT and MRI can measure perfusion parameters of tumor quantitatively and can be used for treatment response assessment to anti-vascular agents. Besides assessing the hemodynamic or perfusion features of HCC, new advances in MRI can provide a cellular information of HCC. Liver-specific hepatobiliary contrast agents, such as gadoxetic acid, give information regarding hepatocellular function or defect of the lesion, which improves lesion detection and characterization. Diffusion-weighted imaging (DWI) of the liver provides cellular information of HCC and also has broadened its role in lesion detection, lesion characterization, and treatment response assessment to chemotherapeutic agents. In this article, we provide an overview of the state-of-the art imaging techniques of the liver and their clinical role in management of HCC.

Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. Accurate diagnosis and assessment of disease extent are crucial for proper management of patients with HCC. Imaging plays a crucial role in early detection, accurate staging, and the planning of management strategies. A variety of imaging modalities are currently used in evaluating patients with suspected HCC; these include ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, and angiography. Among these modalities, dynamic MRI and CT are regarded as the best imaging techniques available for the noninvasive diagnosis of HCC. Recent improvements in CT and MRI technology have made noninvasive and reliable diagnostic assessment of hepatocellular nodules possible in the cirrhotic liver, and biopsy is frequently not required prior to treatment. Until now, the major challenge for radiologists in imaging cirrhosis has been the characterization of small cirrhotic nodules smaller than 2 cm in diameter. Further technological advancement will undoubtedly have a major impact on liver tumor imaging. The increased speed of data acquisition in CT and MRI has allowed improvements in both spatial and temporal resolution, which have made possible a more precise evaluation of the hemodynamics of liver nodules. Furthermore, the development of new, tissue-specific contrast agents such as gadoxetic acid has improved HCC detection on MRI. In this review, we discuss the role of CT and MRI in the diagnosis and staging of HCC, recent technological advances, and the strengths and limitations of these imaging modalities.

To evaluate the diagnostic values of CT findings of nutcracker syndrome (NCS).Twenty seven subjects that underwent CT and renal venography, were divided into three groups based on the venographic renocaval pressure gradient (PG) and collateral veins of the left renal vein (LRV): non-compensated NCS patients with PG≥3 mm Hg (group 1, n=12), partially compensated NCS patients with borderline PG (13 mm Hg) and collateral veins (group 2, n=6), and control group with low PG (0-1 mm Hg) without collateral veins (group 3, n=9). The CT findings were analyzed with regard to abrupt narrowing of the LRV with an acute angle (beak sign), aortomesenteric angle between the superior mesenteric artery and aorta on sagittal images, and LRV diameter ratio (hilar-aortomesenteric).Beak sign of the LRV was found in 91.7% (11/12) of group 1, 50% (3/6) of group 2, and in 11.1% (1/9) of group 3 with the significant difference between groups 1 and 3 (P.05, χ2 test). Mean values of all quantitative CT parameters differed significantly only between groups 1 and 3 (P.05, one-way ANOVA test). For differentiating the non-compensated NCS from the control group, the beak sign showed 91.7% sensitivity and 88.9% specificity. Of the various CT parameters, the beak sign and LRV diameter ratio of ≥4.9 showed the greatest diagnostic accuracy (AUC 0.903, ROC analysis).Beak sign of the LRV and CT findings can be useful in diagnosing the non-compensated NCS.

This report describes two cases of women who presented with huge abdominal masses. Those lesions were large, invasive, extrauterine masses, which showed inhomogeneous signal intensities at magnetic resonance image (MRI). After work-up and surgery, the masses were identified as extremely rare malignant mixed Mullerian tumors that did not originate from the uterus. We have focused on the MRI findings of the tumors, with a review of the literature. J. Magn. Reson. Imaging 2010;32:1238–1241. © 2010 Wiley-Liss, Inc.

Objective In a proof of concept study, we compared no-touch radiofrequency ablation (NtRFA) in bipolar mode with conventional direct tumor puncture (DTP) in terms of local tumor control (LTC), peritoneal seeding, and tumorigenic factors, in the rabbit VX2 subcapsular hepatic tumor model. Materials and methods Sixty-two rabbits with VX2 subcapsular hepatic tumors were divided into three groups according to the procedure: DTP-RFA (n = 25); NtRFA (n = 25); and control (n = 12). Each of the three groups was subdivided into two sets for pathologic analysis (n = 24) or computed tomography (CT) follow-up for 6 weeks after RFA (n = 38). Ultrasonography-guided DTP-RFA and NtRFA were performed nine days after tumor implantation. LTC was defined by either achievement of complete tumor necrosis on histopathology or absence of local tumor progression on follow-up CT and autopsy. Development of peritoneal seeding was also compared among the groups. Serum hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF) and interleukin-6 (IL-6) were measured via ELISA (Elabscience Biotechnology Co.) after RFA for tumorigenic factor evaluation. Results Regarding LTC, there was a trend in NtRFA (80%, 20/25) toward better ablation than in DTP-RFA (56%, 14/25) (p = 0.069). Complete tumor necrosis was achieved in 54.5% of DTP-RFA (6/11) and 90.9% of NtRFA (10/11). Peritoneal seeding was significantly more common in DTP-RFA (71.4%, 10/14) than in NtRFA (21.4%, 3/14) (p = 0.021) or control (0%). Elevations of HGF, VEGF or IL-6 were not detected in any group. Conclusion No-touch radiofrequency ablation led to lower rates of peritoneal seeding and showed a tendency toward better LTC than DTP-RFA.

Purpose To evaluate technical success and clinical efficacy of crisscross-configured dual biliary stent implantation in patients with a biliary hilar tumor extending beyond the segmental ducts. Materials and Methods Between January 2002 and December 2006, two metallic stents were placed crossing each other in a hepatic hilum in 42 patients. One stent was placed between one right sectoral duct and the left hepatic duct and the other was placed between another right sectoral duct and the common bile duct. The patients ranged in age from 36 to 83 years (mean, 63.3 y) and included 26 men and 16 women. Technical success, clinical success, complications, and long-term results were analyzed by retrospective review. Results Stent placement was performed through two right accesses ( n = 30), one right and one left access ( n = 3), or two right accesses and one left access ( n = 6). Successful "trisectoral" drainage was obtained with two stents in 41 patients (98%). In one case of initial technical failure, an additional stent was needed to connect the two previously placed stents. Clinical success was obtained in 34 of the remaining 36 patients (92%). No procedure-related major complication was observed. The median primary stent patency time was 187 days and the median patient survival time was 247 days. Conclusions Crisscross-configured dual stent implantation is a feasible, safe, and effective method to maximize hepatic drainage with a minimal number of stents in patients with advanced biliary hilar malignancy.

Intracortical lipoma is an extremely rare benign primary bone tumor. We encountered a case of an intracortical lipoma found incidentally in the femur of a 31-year-old female. Magnetic resonance imaging and computed tomography of the femur demonstrated an intracortical fatty lesion in the posterolateral aspect of the diaphysis. The intracortical lesion showed some intramedullary extension, multiple septations, and dot-like calcifications. Intralesional curettage was performed. Histologically, the tumor consisted of mature, viable adipocytes without foci of fat necrosis or dystrophic calcification.

OBJECTIVE To determine whether triple arterial phase acquisition via a combination of Contrast Enhanced Time Robust Angiography, keyhole, temporal viewsharing and parallel imaging can improve arterial phase acquisition with higher spatial resolution than single arterial phase gadoxetic-acid enhanced magnetic resonance imaging (MRI). MATERIALS AND METHODS Informed consent was waived for this retrospective study by our Institutional Review Board. In 752 consecutive patients who underwent gadoxetic acid-enhanced liver MRI, either single (n = 587) or triple (n = 165) arterial phases was obtained in a single breath-hold under MR fluoroscopy guidance. Arterial phase timing was assessed, and the degree of motion was rated on a four-point scale. The percentage of patients achieving the late arterial phase without significant motion was compared between the two methods using the χ(2) test. RESULTS The late arterial phase was captured at least once in 96.4% (159/165) of the triple arterial phase group and in 84.2% (494/587) of the single arterial phase group (p < 0.001). Significant motion artifacts (score ≤ 2) were observed in 13.3% (22/165), 1.2% (2/165), 4.8% (8/165) on 1st, 2nd, and 3rd scans of triple arterial phase acquisitions and 6.0% (35/587) of single phase acquisitions. Thus, the late arterial phase without significant motion artifacts was captured in 96.4% (159/165) of the triple arterial phase group and in 79.9% (469/587) of the single arterial phase group (p < 0.001). CONCLUSION Triple arterial phase imaging may reliably provide adequate arterial phase imaging for gadoxetic acid-enhanced liver MRI.

To determine the different imaging features of intrahepatic mass-forming cholangiocarcinoma (IMCC) from hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced magnetic resonance imaging (MRI). This retrospective study was institutional review board approved and the requirement for informed consent was waived. Patients who underwent gadoxetic acid-enhanced MRI with histologically confirmed IMCCs (n = 46) or HCCs (n = 58) were included. Imaging features of IMCCs and HCCs on gadoxetic acid-enhanced MRI including T2- and T1-weighted, diffusion weighted images, dynamic study and hepatobiliary phase (HBP) images were analyzed. Univariate and multivariate logistic regression analyses were performed to identify relevant differentiating features between IMCCs and HCCs. Multivariate analysis revealed heterogeneous T2 signal intensity and a hypointense rim on the HBP as suggestive findings of IMCCs and the wash-in and “portal wash-out” enhancement pattern as well as focal T1 high signal intensity foci as indicative of HCCs (all, p

To evaluate the diagnostic performance of magnetic resonance (MR) fat quantification and MR elastography for the assessment of hepatic steatosis and fibrosis in living liver donor candidates.This retrospective study was approved by the institutional review board, and the requirement of informed consent was waived. Donors who underwent MR fat quantification and MR elastography at 1.5 T, followed by liver biopsy, were chronologically grouped into test and validation groups. In the test group (n = 362), MR fat fraction and liver stiffness were compared among donors with normal parenchyma (n = 244), simple steatosis (n = 71), steatosis with inflammatory activity (n = 21), nonalcoholic steatohepatitis (n = 17), and fibrosis (n = 9). Diagnostic performance of the two techniques was assessed by using receiver operating characteristic curve analysis for the detection of substantial steatosis (macrovesicular fat ≥ 10%) or fibrosis (≥F1) and was tested in a validation group (n = 34).In the test group, donors with steatosis showed significantly higher fat fraction than donors without steatosis (P.0001), and donors with fibrosis and nonalcoholic steatohepatitis showed significantly higher liver stiffness values than donors without fibrosis (P.0001). Areas under the curve were 0.93 (cutoff value5.8%) for MR fat quantification and 0.85 (cutoff value1.94 kPa) for MR elastography. By using those values, the combination of the two techniques could be used to detect substantial steatosis or fibrosis with 100% sensitivity (12 of 12 patients, 95% confidence interval: 73.4%, 100%) and 100% negative predictive value (15 of 15 patients, 95% confidence interval: 78.0%, 100%) in the validation group.A combination of MR fat quantification and MR elastography can provide sufficient sensitivity to detect substantial steatosis or fibrosis (≥F1) in liver donor candidates.

Background Regorafenib induces distinct radiological changes that represent its anti-angiogenic effect. However, clinical implication of the changes is unclear. Methods Tumor attenuation as measured by Hounsfield units (HU) in contrast-enhanced computed tomography (CT) and cavitary changes of lung metastases were analyzed in association with treatment outcome of metastatic colorectal cancer patients (N = 80) treated with regorafenib in a prospective study. Results 141 lesions in 72 patients were analyzed with HU. After 2 cycles of regorafenib, 87.5% of patients showed decrease of HU (Median change -23.9%, range -61.5%–20.7%). Lesional attenuation change was modestly associated with metabolic changes of 18-fluoro-deoxyglucose positron emission tomography-CT (Pearson’s r = 0.37, p = 0.002). Among 53 patients with lung metastases, 17 (32.1%) developed cavitary changes. There were no differences in disease control rate, progression-free survival, or overall survival according to the radiological changes. At the time of progressive disease (PD) according to RECIST 1.1, HU was lower than baseline in 86.0% (43/50) and cavitary change of lung metastasis persisted without refilling in 84.6% (11/13). Conclusion Regorafenib showed prominent anti-angiogenic effect in colorectal cancer, but the changes were not associated with treatment outcome. However, the anti-angiogenic effects persisted at the time of PD, which suggests that we may need to develop new treatment strategies.

Purpose We retrospectively investigated the feasibility and clinical efficacy of balloon dilatation and subsequent retrievable stent insertion, when necessitated, for pyloric spasms after pylorus-preserving gastrectomy (PPG). Materials and Methods Forty-five patients experiencing pyloric spasms after PPG underwent fluoroscopic balloon dilations to alleviate obstructive symptoms due to delayed gastric emptying. Patients showing poor response to balloon dilation underwent subsequent retrievable stent insertion. Safety of the procedures was analyzed, and subjective symptoms and objective signs of pyloric spasms were analyzed and compared before and after treatment. Results Thirty-three patients (73.3%, 33/45) showed good response to balloon dilatation requiring no further treatment (balloon group). Conversely, 12 patients (26.7%, 12/45) showed poor or no response after balloon dilation requiring subsequent stent insertion (stent group). Balloon dilations and/or stent insertions were safely performed in all patients except one patient who suffered a transmural tear after balloon dilatation. In both groups, mean subjective symptom score was significantly improved and mean pyloric canal-to-height of the adjacent vertebral body ratio was significantly increased after the procedures (P

The purpose of the study is to evaluate the influence of the adaptive iterative dose reduction (AIDR 3D) algorithm on the detectability of low-contrast focal liver lesions (FLLs) and the radiation dose repeatability of automatic tube current modulation (ATCM) in abdominal CT scans using anthropomorphic phantoms. Three different sizes of anthropomorphic phantoms, each with 4 low-contrast FLLs, were scanned on a 320-channel CT scanner using the ATCM technique and AIDR 3D, at different radiation doses: full-dose, half-dose, and quarter-dose. Scans were repeated three times and reconstructed with filtered back projection (FBP) and AIDR 3D. Radiation dose repeatability was assessed using the intraclass correlation coefficient (ICC). Image noise, quality, and lesion conspicuity were assessed by four reviewers and the number of invisible FLLs was compared among different radiation doses and reconstruction methods. ICCs of radiation dose among the three CT scans were excellent in all phantoms (0.99). Image noise, quality, and lesion conspicuity in the half-dose group were comparable with full-dose FBP after applying AIDR 3D in all phantoms. In small phantoms, the half-dose group reconstructed with AIDR 3D showed similar sensitivity in visualizing low-contrast FLLs compared to full-dose FBP (P = 0.77–0.84). In medium and large phantoms, AIDR 3D reduced the number of missing low-contrast FLLs [3.1% (9/288), 11.5% (33/288), respectively], compared to FBP [10.4% (30/288), 21.9% (63/288), respectively] in the full-dose group. By applying AIDR 3D, half-dose CT scans may be achievable in small-sized patients without hampering diagnostic performance, while it may improve diagnostic performance in medium- and large-sized patients without increasing the radiation dose.

OBJECTIVE The purpose of this study was to determine whether hepatic extracellular volume fractions (fECVs) measured using multiphasic liver computed tomography (CT) can be used to quantify the severity of hepatic fibrosis (HF). MATERIALS AND METHODS This retrospective study was approved by our institutional review board, and the requirement for informed consent was waived. A total of 141 patients (male-female ratio, 109:32; mean [SD] age, 59.4 [11.4] years) histologically diagnosed with HF (F0-F1 = 33 and F2-F4 = 108) underwent multiphasic liver CT. Absolute enhancements (in Hounsfield unit) of the liver parenchyma (Eliver) and aorta (Eaorta) 3 minutes after contrast administration were measured on subtraction images of precontrast and equilibrium phase scans using nonrigid registration software. The fECV was calculated using the following equation: fECV (%) = Eliver/Eaorta × (100 - Hematocrit [%]). Correlation between fECV and HF stage was evaluated using the Spearman correlation coefficient. The fECVs were compared between F0-F1 and ≥F2 as well as between child A and child B or C. Diagnostic performance of fECV in predicting significant HF (≥F2) was assessed using receiver operating curve analysis. RESULTS The fECVs showed a significant correlation with pathologic HF staging (r = 0.493, P < 0.001). The F2-F4 showed significantly higher fECVs than did F0 to F1 (33.6% [4.7%] vs 27.7% [4.4%]; P < 0.001). The fECVs were significantly higher in the patients with child B or C than those with child A (35.2% [7.0%] vs 31.3% [4.2%]; P < 0.001). The fECV values higher than 28.76% provided 87.5% sensitivity and 71.0% specificity in detecting significant HF (area under the curve, 0.832; P < 0.0001). CONCLUSIONS Because fECV was shown to increase along with HF progression, the estimation of fECV using routine multiphasic liver CT may have the potential to detect significant HF.

Objective To evaluate the applicability, reproducibility, and diagnostic performance of a new 2D-shear wave elastography (SWE) using the comb-push technique (2D CP-SWE) for detection of hepatic fibrosis, using histopathology as the reference standard. Materials and methods This prospective study was approved by the institutional review board, and informed consent was obtained from all patients. The liver stiffness (LS) measurements were obtained from 140 patients, using the new 2D-SWE, which uses comb-push excitation to produce shear waves and a time-aligned sequential tracking method to detect shear wave signals. The applicability rate of 2D CP-SWE was estimated, and factors associated with its applicability were identified. Intraobserver reproducibility was evaluated in the 105 patients with histopathologic diagnosis, and interobserver reproducibility was assessed in 20 patients. Diagnostic performance of the 2D CP-SWE for hepatic fibrosis was evaluated by receiver operating characteristic (ROC) curve analysis. Results The applicability rate of 2D CP-SWE was 90.8% (109 of 120). There was a significant difference in age, presence or absence of ascites, and the distance from the transducer to the Glisson capsule between the patients with applicable LS measurements and patients with unreliable measurement or technical failure. The intraclass correlation of interobserver agreement was 0.87, and the value for the intraobserver agreement was 0.95. The area under the ROC curve of LS values for stage F2 fibrosis or greater, stage F3 or greater, and stage F4 fibrosis was 0.874 (95% confidence interval [CI]: 0.794–0.930), 0.905 (95% CI: 0.832–0.954), and 0.894 (95% CI: 0.819–0.946), respectively. Conclusion 2D CP-SWE can be employed as a reliable method for assessing hepatic fibrosis with a reasonably good diagnostic performance, and its applicability might be influenced by age, ascites, and the distance between the transducer and Glisson capsule.