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Diffuse Liver Diseases

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Diffusion Weighted Imaging of the Hepatobiliary System

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Abstract

As a noninvasive imaging method, diffusion-weighted magnetic resonance imaging (DWI) has been investigated to yield information on tissue microstructure and perfusion in diffuse liver diseases.

The variability in reported diffusion parameter values and diagnostic performance of DWI can be improved by choosing acquisition parameters which provide high signal-to-noise ratio and fat saturation, and which limit artefacts related to motion and echo-planar imaging. At the processing level, the size of the regions-of-interest and the calculation protocol should be optimized. A final recommendation pertains to repeatability of diffusion parameters: ideally, acquisition and processing protocols should be tested for short-term repeatability in patients, and repeatability coefficients should be compared with the parameter difference observed between disease stages to conclude on diagnostic performance. This is particularly important for the perfusion-related diffusion coefficient, which presents higher variability than the other diffusion parameters.

DWI can assess the histopathological features associated with diffuse liver diseases, such as fibrosis and steatosis. Fibrosis is characterized by accumulation of extracellular matrix which may hinder water diffusion, and by decreased hepatic perfusion. Fibrosis decreases the apparent diffusion coefficient (ADC) and the perfusion-related intravoxel incoherent motion (IVIM) parameters, with moderate to high diagnostic performance. DWI could thus help diagnosing and staging liver fibrosis in patients when ultrasound and MR elastography are not readily available. Concerning steatosis, the presence of lipid vacuoles within the hepatocytes and the impaired hepatic perfusion induce a decrease in the molecular diffusion coefficient and the perfusion-related IVIM parameters, respectively. Steatosis is thus an important confounding factor when assessing liver fibrosis with DWI, as is iron overload. In contrast, liver inflammation often weakly influences the diffusion parameters.

Finally, to strengthen the benefit of using DWI in the diagnosis of diffuse liver diseases, several new avenues are explored, including the study of the fibrotic patterns by texture analysis, the use of long gradient separation times coupled with a stimulated-echo acquisition mode to assess large diffusion distances, and the study of non-Gaussian diffusion for calculating tissue mechanical properties with DWI. These approaches need to be further investigated and validated before being integrated in clinical routine.

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Abbreviations

ADC:

Apparent diffusion coefficient

AUC:

Area under the receiver operating characteristic (ROC) curve

CR:

Coefficient of reproducibility

CV:

Coefficient of variation

Δ :

Gradient separation time

D :

Molecular diffusion coefficient

D * :

Perfusion-related diffusion coefficient

DWI:

Diffusion-weighted magnetic resonance imaging

EPI:

Echo-planar imaging

f :

Perfusion fraction

HCV:

Hepatitis C virus infection

IVIM:

Intravoxel incoherent motion

MR:

Magnetic resonance

NAFLD:

Nonalcoholic fatty liver disease

NASH:

Nonalcoholic steatohepatitis

ROI:

Region-of-interest

SNR:

Signal-to-noise ratio

TE:

Echo time

TR:

Repetition time

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Authors and Affiliations

  1. Laboratory of Imaging Biomarkers, Center of Research on Inflammation, UMR 1149 Inserm—University of Paris, 75018 Paris, France

    Sabrina Doblas, Philippe Garteiser & Bernard E. Van Beers

  2. Department of Radiology, Beaujon University Hospital Paris Nord, AP-HP, 92110 Clichy, France

    Bernard E. Van Beers

Authors
  1. Sabrina Doblas
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  2. Philippe Garteiser
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  3. Bernard E. Van Beers
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Corresponding author

Correspondence to Bernard E. Van Beers .

Editor information

Editors and Affiliations

  1. Department of Radiology, Champalimaud Foundation, Lisbon, Portugal

    Celso Matos

  2. Department of Radiology, Champalimaud Foundation, Lisbon, Portugal

    Nickolas Papanikolaou

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Doblas, S., Garteiser, P., Van Beers, B.E. (2021). Diffuse Liver Diseases. In: Matos, C., Papanikolaou, N. (eds) Diffusion Weighted Imaging of the Hepatobiliary System. Springer, Cham. https://doi.org/10.1007/978-3-319-62977-3_4

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  • DOI: https://doi.org/10.1007/978-3-319-62977-3_4

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