Why early diagnosis is important
Liver disease is known as a silent disease because in the early stages most people are not aware that they have it. If liver disease is not diagnosed and treated then eventually it can lead to liver failure and require a liver transplant.
However, the liver has an amazing capacity to regenerate. If liver disease is diagnosed before severe liver damage occurs, it may be possible to take medication or make lifestyle changes that can cure or control the disease. This will reduce the risk of needing a liver transplant.Find out more about liver conditions
What tests will I need?
If you are at risk of having a liver disease you may need to have a variety of tests to get a diagnosis and to assess how much liver damage you have. These may include blood tests, ultrasound scans, MRI scans and liver biopsies. Some of these tests are quick and painless whilst others, such as liver biopsies, are more complicated and might involve an overnight stay in hospital.
How can we help?
LiverMultiScan is a diagnostic aid for liver disorders that uses multiparametric Magnetic Resonance Imaging (MRI) to quantify liver tissue. LiverMultiScan is non-invasive and characterizes liver tissue by providing quantitative measures of liver fat, and correlates of iron, fibrosis and inflammation.
LiverMultiScan is FDA 510(k) cleared in the U.S. and CE marked by notified body BSI 2797 in Europe to aid clinicians in the diagnosis of liver disorders and abnormalities. It can be used as part of the diagnostic pathway for patients. LiverMultiScan is delivered as a service and does not require any additional hardware installation and is standardized across manufacturers and field strengths.
Perspectum’s latest product, MRCP+ allows existing MRCP data to be enhanced and quantitatively characterized using advanced image processing techniques. The technology can enhance the data from conventional MRCP without needing to inject contrast agent, enabling 3D visualization of ducts. MRCP+ is 510(k) cleared from the FDA and CE marked in Europe.
MRCP+ calculates quantitative 3D biliary system models that enable measurement of bile duct widths and automatic detection of regions of variation of duct widths. MRCP+ includes tools for interactive segmentation and labelling of the biliary system and structures. It allows for regional volumetric analysis of the biliary tree, pancreatic duct, and gallbladder.
What will happen during the scan?
The radiographer will help you to get into a comfortable position on the scanning bed. You will have a large plastic belt (known as a coil) strapped across your abdomen. You will be given headphones so that you can talk to the radiographer during the scan. You will also be given a button to press in case you want to come out of the scanner before the scan is finished.
Once you are comfortable the radiographer will move the bed into the center of the scanner. You will be asked to lie still, breathe in and out and hold your breath for several seconds while your liver is scanned. It is quite noisy inside the scanner but the headphones will help to reduce the volume. You will be in the scanner for between 5-10 minutes.
What does cT1 show?
cT1 stands for ‘corrected T1’, which is a measure of inflammation and fibrosis. T1 is the name of an MRI sequence that is often used in the assessment of tissue inflammation and fibrosis. However, uniquely for a liver test, LiverMultiScan ‘corrects’ the T1 for the effects of iron, for which the liver is a major storage point. Because of this, LiverMultiScan, via the cT1 score, has been shown to be able to assess the levels of inflammation and fibrosis in the liver accurately.
It is important to be able to accurately assess inflammation and fibrosis as it indicates how damaged the liver is. If inflammation and fibrosis persist this can progress to cirrhosis, which can lead to liver failure.
What do the colors on the cT1 map mean?
The map shows a flat slice through the body. The defined triangular shape on the left-hand side of the image is the liver. The coloring is just a way to demonstrate what values of cT1 the liver tissue has within the area shown. Cooler colors mean a lower cT1 score, and warmer colors show a higher cT1 score.
In the example used, some of the tissue has a lower cT1 value and some of the tissue has a higher cT1 value, meaning that the patient could potentially have liver damage, but only in some areas of the liver. This is often called ‘heterogenous’ or ‘patchy’ disease. In some people, the health of the liver is more consistent throughout the tissue. Blood vessels also sometimes show up as a red and purple color on the scan, so it is best to ask your physician if you are confused about what your scan says.
What does T2* show?
T2* is a type of MRI sequence that is generally used within the liver context to assess whether there is an excess of iron in the liver. Iron can damage the liver if present in excess and so measuring its value is important when making an assessment of liver health. Our collaborative work with the UK Biobank project has estimated that almost 5% of the UK population have higher than normal liver iron. Accurate T2* assessment is also important to the quantification of cT1, our measure of inflammation and fibrosis.
In the example shown, the patient is recovering from liver damage caused by excess liver iron, something they have been treated for. This explains why the T2* is quite close to what is considered normal. It is important to note with T2* that it decreases as liver iron increases, meaning a lower T2* score is indicative of higher liver iron storage.
What does PDFF show?
Proton Density Fat Fraction (PDFF), is a method by which liver fat percentage can be measured, with 5.6%1 considered the cut-off for normal. Anything above this level is considered to be indicative of Fatty Liver Disease, something that up to 1 in 3 in the UK population suffer from. Left untreated, Fatty Liver Disease, sometimes called Non-Alcoholic Fatty Liver Disease (NAFLD) can progress to the much more serious Non-alcoholic Steatohepatitis (NASH), so being able to identify NAFLD early is very useful. The PDFF measure LiverMultiScan utilizes can be used in conjunction with our cT1 measure to tell apart mild from significant NAFLD. This is important for early diagnosis.
The person in the example shown here has normal liver fat, helping their physician to rule out a diagnosis of Fatty Liver Disease.