A comparative study of MR extracellular volume fraction measurement and two-dimensional shear-wave elastography in assessment of liver fibrosis with chronic hepatitis B

  • Kaipu Jin
  • Heqing Wang
  • Mengsu Zeng
  • Shengxiang Rao
  • Lixia Yan
  • Yuan Ji
  • Caixia Fu
  • Ruofan ShengEmail author



To evaluate the value of MR liver extracellular volume (ECVliver) in assessment of liver fibrosis with chronic hepatitis B (CHB), and to compare its performance with two-dimensional (2D) shear-wave elastography (SWE).

Materials and methods

A total of 68 CHB patients who were histologically diagnosed as fibrosis stages F0 to F4 were retrospectively analyzed. All patients underwent gadopentetate dimeglumine-enhanced T1-mapping and 2D SWE. ECVliver and liver stiffness were measured and compared between fibrosis subgroups; their correlations with histologic findings were evaluated using Spearman correlation test and multiple regression analysis. Diagnostic performance in evaluating liver fibrosis stages was assessed and compared using receiver-operating characteristic analysis.


Both ECVliver and liver stiffness increased as the fibrosis score increased (F = 17.08 to 10.99, P < 0.001). ECVliver displayed a strong correlation with fibrosis stage (r = 0.740, P < 0.001), and liver stiffness displayed a moderate correlation (r = 0.651, P < 0.001); multivariate analysis revealed that only ECVliver was independently correlated with fibrosis stage (P < 0.001). Univariate analyses showed significant correlations of ECVliver with fibrosis stage, inflammatory activity, and platelet count; among all, the fibrosis stage had the highest correlation coefficient and was the only independent factor (P < 0.001). Overall, ECVliver had no significant different performance compared with 2D SWE for the identification of both fibrosis stage s ≥ F2 and F4 (P = 0.868 and 0.171).


MR ECVliver plays a promising role in the prediction of liver fibrosis for patients with CHB, comparable to 2D SWE.


Liver fibrosis Extracellular space Magnetic resonance imaging Sonoelastography Chronic hepatitis B Cirrhosis 



This work was supported by the National Natural Science Foundation for Young Scientists of China [grant number 81601488]; the Shanghai Sailing Program [grant number 16YF1410600]; and the National Natural Science Foundation of China [grant number 81571661].


  1. 1.
    Lok AS, McMahon BJ, Brown RS, Jr., Wong JB, Ahmed AT, Farah W, Almasri J, Alahdab F, Benkhadra K, Mouchli MA, Singh S, Mohamed EA, Abu Dabrh AM, Prokop LJ, Wang Z, Murad MH, Mohammed K (2016) Antiviral therapy for chronic hepatitis B viral infection in adults: A systematic review and meta-analysis. Hepatology 63 (1):284–306. CrossRefGoogle Scholar
  2. 2.
    Polasek M, Fuchs BC, Uppal R, Schuehle DT, Alford JK, Loving GS, Yamada S, Wei L, Lauwers GY, Guimaraes AR, Tanabe KK, Caravan P (2012) Molecular MR imaging of liver fibrosis: A feasibility study using rat and mouse models. J Hepatol 57 (3):549–555. CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Barr RG, Ferraioli G, Palmeri ML, Goodman ZD, Garcia-Tsao G, Rubin J, Garra B, Myers RP, Wilson SR, Rubens D, Levine D (2015) Elastography Assessment of Liver Fibrosis: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology 276 (3):845–861. CrossRefGoogle Scholar
  4. 4.
    Marcellin P, Gane E, Buti M, Afdhal N, Sievert W, Jacobson IM, Washington MK, Germanidis G, Flaherty JF, Aguilar Schall R, Bornstein JD, Kitrinos KM, Subramanian GM, McHutchison JG, Heathcote EJ (2013) Regression of cirrhosis during treatment with tenofovir disoproxil fumarate for chronic hepatitis B: a 5-year open-label follow-up study. Lancet 381 (9865):468–475. CrossRefGoogle Scholar
  5. 5.
    Yoon JH, Lee JM, Baek JH, Shin C-i, Kiefer B, Han JK, Choi B-I (2014) Evaluation of Hepatic Fibrosis Using Intravoxel Incoherent Motion in Diffusion-Weighted Liver MRI. J Comput Assist Tomogr 38 (1):110–116. CrossRefGoogle Scholar
  6. 6.
    Zhuang Y, Ding H, Zhang Y, Sun HC, Xu C, Wang WP (2017) Two-dimensional Shear-Wave Elastography Performance in the Noninvasive Evaluation of Liver Fibrosis in Patients with Chronic Hepatitis B: Comparison with Serum Fibrosis Indexes. Radiology 283 (3):872–881. CrossRefGoogle Scholar
  7. 7.
    Barr RG (2017) Shear wave liver elastography. Abdom Radiol (NY).
  8. 8.
    Bandula S, Punwani S, Rosenberg WM, Jalan R, Hall AR, Dhillon A, Moon JC, Taylor SA (2015) Equilibrium Contrast-enhanced CT Imaging to Evaluate Hepatic Fibrosis: Initial Validation by Comparison with Histopathologic Analysis. Radiology 275 (1):136–143. CrossRefGoogle Scholar
  9. 9.
    Everett RJ, Stirrat CG, Semple SIR, Newby DE, Dweck MR, Mirsadraee S (2016) Assessment of myocardial fibrosis with T1 mapping MRI. Clin Radiol 71 (8):768-778. CrossRefPubMedGoogle Scholar
  10. 10.
    Brouwer WP, Baars EN, Germans T, de Boer K, Beek AM, van der Velden J, van Rossum AC, Hofman MBM (2014) In-vivo T1 cardiovascular magnetic resonance study of diffuse myocardial fibrosis in hypertrophic cardiomyopathy. J Cardiovasc Magn Reson.
  11. 11.
    Schelbert EB, Messroghli DR (2016) State of the Art: Clinical Applications of Cardiac T1 Mapping. Radiology 278 (3):658–676. CrossRefPubMedGoogle Scholar
  12. 12.
    Bandula S, Banypersad SM, Sado D, Flett AS, Punwani S, Taylor SA, Hawkins PN, Moon JC (2013) Measurement of Tissue Interstitial Volume in Healthy Patients and Those with Amyloidosis with Equilibrium Contrast-enhanced MR Imaging. Radiology 268 (3):858–864. CrossRefPubMedGoogle Scholar
  13. 13.
    Luetkens JA, Klein S, Traeber F, Schmeel FC, Sprinkart AM, Kuetting DLR, Block W, Hittatiya K, Uschner FE, Schierwagen R, Gieseke J, Schild HH, Trebicka J, Kukuk GM (2017) Quantitative liver MRI including extracellular volume fraction for non-invasive quantification of liver fibrosis: a prospective proof-of-concept study. Gut.
  14. 14.
    Wells ML, Moynagh MR, Carter RE, Childs RA, Leitch CE, Fletcher JG, Yeh BM, Venkatesh SK (2017) Correlation of hepatic fractional extracellular space using gadolinium enhanced MRI with liver stiffness using magnetic resonance elastography. Abdom Radiol (NY) 42 (1):191–198. CrossRefGoogle Scholar
  15. 15.
    Goodman ZD (2007) Grading and staging systems for inflammation and fibrosis in chronic liver diseases. J Hepatol 47 (4):598–607. CrossRefPubMedGoogle Scholar
  16. 16.
    Karlik SJ (2003) Exploring and summarizing radiologic data. AJR Am J Roentgenol 180 (1):47–54CrossRefPubMedGoogle Scholar
  17. 17.
    DDelong ER, Delong DM, Clarkepearson DI (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44 (3):837–845. CrossRefPubMedGoogle Scholar
  18. 18.
    Guo SL, Su LN, Zhai YN, Chirume WM, Lei JQ, Zhang H, Yang L, Shen XP, Wen XX, Guo YM (2017) The clinical value of hepatic extracellular volume fraction using routine multiphasic contrast-enhanced liver CT for staging liver fibrosis. Clin Radiol 72 (3):242–246. CrossRefGoogle Scholar
  19. 19.
    Varenika V, Fu Y, Maher JJ, Gao D, Kakar S, Cabarrus MC, Yeh BM (2013) Hepatic Fibrosis: Evaluation with Semiquantitative Contrast-enhanced CT. Radiology 266 (1):151–158. CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Moreira RK (2007) Hepatic stellate cells and liver fibrosis. Arch Pathol Lab Med 131 (11):1728–1734.[1728:hscalf];2 CrossRefPubMedGoogle Scholar
  21. 21.
    Mathew RP, Venkatesh SK (2018) Imaging of Hepatic Fibrosis. Curr Gastroenterol Rep 20 (10):45. CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of RadiologyZhongshan Hospital, Fudan University, Shanghai Institute of Medical ImagingShanghaiPeople’s Republic of China
  2. 2.Department of UltrasoundZhongshan Hospital, Fudan UniversityShanghaiPeople’s Republic of China
  3. 3.Department of PathologyZhongshan Hospital, Fudan UniversityShanghaiPeople’s Republic of China
  4. 4.Siemens HealthcareShanghaiPeople’s Republic of China

Personalised recommendations