MR Elastography

Step 1:

  • Open the study and read through the sequences like normal, looking at T2, T1, in and out of phases

Step 2: Fat Fraction (FF)

  • Find the sequence that allows you to scroll through 4-5 different sequences in one box if you keep scrolling - this is usually 4th to last

    • Usually names METABOLIC mDixon Quant BH

  • The sequences you scroll through will usually be the ones that come after it in the pacs line including the

    • smDIXON Quant BH FF

    • smDIXON Quant BH T2*

    • smDIXON Quant BH R2*

  • Now when you scroll through it you want to look for the one that looks like the smDIXON Quant BH FF

  • The image to left is windowed so you can see it but will look like this probably just a little darker but fat should be bright and liver somewhat dark

  • You now need to draw 3 ROI in the liver on 3 different slices (9 total)

    • The values should be in the 2-30 range, if youre getting 100+ youre in wrong sequence

  • Now put these values into the XCel sheet in teams in peds folder under “liver iron concentration worksheet” at the bottom where it says PDFF values

    • Take the average value and plug it in under your PDFF value

Step 3: Iron levels

  • Keep scrolling on the one series that has multiple linked together until you get to the one that looks like the R2 map

    • It looks hella dark, hard to actually see liver borders tbh

  • Drop 4 ROI on 4 different slices (16 total)

    • These values should be in the 40 range normally

  • Put the ROI values in the XCel sheet at the top labeled “Measured R2 values”

  • This will automatically give you a liver iron quantification below it

    • Use the first liver iron quantification (not the wood or hankin one)

  • Put that value in the template

  • There is a dropdown for you value whether it is normal or not

Step 4: The actual elastography part

  • The techs should have placed 4 ROI while they were scanning them and it should give you 4 pictures that look like this —>

    • Use the last one that has all 4 ROI on it

    • If they did not do this then you’ll have to call them to do it or do it yourself (idk how)

  • Look for the average stiffness value given at bottom (circled in red in pic to left)

    • This is what you put in the template for “Average cumulative hepatic stiffness”

Ref