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Evaluation of fibrosis and inflammation in diffuse liver diseases using intravoxel incoherent motion diffusion-weighted MR imaging

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Abstract

Purpose

The purpose of the study was to evaluate the role of intravoxel incoherent motion (IVIM) diffusion model for the assessment of liver fibrosis and inflammation in diffuse liver disorders, also considering the presence of liver steatosis and iron deposits.

Methods

Seventy-four patients were included, with liver biopsy and a 3 Tesla abdominal magnetic resonance imaging examination, with an IVIM diffusion-weighted sequence (single-shot spin-echo echo-planar sequence, with gradient reversal fat suppression; 6 b-values: 0, 50, 200, 400, 600, and 800 s/mm2). Histological evaluation comprised the Ishak modified scale, for grading inflammation and fibrosis, plus steatosis and iron loading classification. The liver apparent diffusion coefficient (ADC) and IVIM parameters (D, D*, f) were calculated from the IVIM images. The relationship between IVIM parameters and histopathological scores were evaluated by ANOVA and Spearman correlation tests. A test–retest experiment assessed reproducibility and repeatability in 10 healthy volunteers and 10 randomly selected patient studies.

Results

ADC and f values were lower with higher fibrosis stages (p = 0.009, p = 0.006, respectively) and also with higher necro-inflammatory activity grades (p = 0.02, p = 0.017, respectively). Considered together, only fibrosis presented a significant effect on ADC and f measurements (p < 0.05), whereas inflammation had no significant effect (p > 0.05). A mild correlation was found between ADC and f with fibrosis (R S = −0.32 and R S = −0.38; p < 0.05) and inflammation (R S = −0.31 and R S = −0.32, p < 0.05; respectively). The AUROC for ADC and f measurements with the different dichotomizations between fibrosis or inflammation grades were only fair (0.670 to 0.749, p < 0.05). Neither D nor D* values were significantly different between liver fibrosis or inflammation grades. D measurements were significantly different across histologic grades of steatosis (p < 0.001) and iron overload (p < 0.001), whereas f measurements showed significant differences across histologic steatosis grades (p = 0.005). There was an excellent agreement between the different readers for ADC, f, and D.

Conclusions

Although fibrosis presented a significant effect on ADC and f, IVIM measurements are not accurate enough to stage liver fibrosis or necro-inflammatory activity in diffuse liver diseases. D values were influenced by steatosis and iron overload.

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Acknowledgments

This work was partially funded by a research Grant from the Teaching and Research Department of Centro Hospitalar do Porto (DEFI:309/12(213-DEFI/251-CES)) and from a Spanish Ministry of Health and Carlos III Health Institute funding grant (PI12/01262). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Imaging Department, Centro Hospitalar do Porto, Largo Prof Abel Salazar, 4099-001, Porto, Portugal

    Manuela França

  2. Radiology Department, Hospital Universitario y Politécnico La Fe and Biomedical Imaging Research Group (GIBI230), Valencia, Spain

    Luis Martí-Bonmatí & Ángel Alberich-Bayarri

  3. Population Studies Department, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal

    Pedro Oliveira

  4. Epidemiology Research Unit (EPI Unit), Institute of Public Health of the University of Porto, Porto, Portugal

    Pedro Oliveira & Helena Pessegueiro Miranda

  5. Pathology Department, Centro Hospitalar de S. João, Porto, Portugal

    Susana Guimaraes

  6. Radiology Department, Centro Hospitalar do Porto, Porto, Portugal

    João Oliveira & João Amorim

  7. MR Clinical Science, Philips Healthcare, Madrid, Spain

    Javier Sanchez Gonzalez

  8. Pathology Department, Centro Hospitalar do Porto, Porto, Portugal

    José Ramón Vizcaíno

  9. Liver and Pancreas Transplantation Unit and Medicine Department, Centro Hospitalar do Porto, Porto, Portugal

    Helena Pessegueiro Miranda

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  1. Manuela França
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Correspondence to Manuela França.

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Conflicts of interest

Javier Sanchez Gonzalez is employee at Philips Healthcare Iberia. Angel Alberich Bayarri and Luis Martí-Bonmatí are co-founders of QUIBIM SME. The remaining authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Written informed consent was obtained from all patients.

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França, M., Martí-Bonmatí, L., Alberich-Bayarri, Á. et al. Evaluation of fibrosis and inflammation in diffuse liver diseases using intravoxel incoherent motion diffusion-weighted MR imaging. Abdom Radiol 42, 468–477 (2017). https://doi.org/10.1007/s00261-016-0899-0

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