Assessment of liver fibrosis with gadoxetic acid-enhanced MRI: comparisons with transient elastography, ElastPQ, and serologic fibrosis markers
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To compare the diagnostic performance of gadoxetic acid-enhanced magnetic resonance imaging (MRI), ultrasonography (US)—based elastography, and serologic fibrosis markers in assessing the stage of liver fibrosis.
Materials and methods
This retrospective study included 67 patients (55 male and 12 female; mean age 62.5 years) who underwent gadoxetic acid-enhanced MRI and liver stiffness measurements before liver biopsy or surgery between January 2014 and January 2018. Measurements were performed using transient elastography (TE), ultrasound shear wave elastography point quantification (ElastPQ), and blood tests. The following MRI-based fibrosis markers were assessed: contrast enhancement index (CEI), liver–spleen contrast ratio (LSC), liver–portal vein contrast ratio (LPC), and signal intensity ratio (SIR). The diagnostic performances of fibrosis markers were compared using the area under the receiver operating characteristic curve (AUC), with histopathologic fibrosis stage as the reference standard.
The fibrosis stages were F0–F1 (n = 17), F2 (n = 7), F3 (n = 20), and F4 (n = 23). MRI-based fibrosis markers negatively correlated with histologic stage: CEI (r = –0.786); LSC (r = − 0.718); LPC (r = − 0.448); and SIR (r = − 0.617; all P < 0.001). For diagnosis of either significant liver fibrosis (≥ F2) or cirrhosis (F4), the CEI provided better diagnostic accuracy (AUC = 0.898 and 0.881) than the aspartate aminotransferase-to-platelet ratio index (APRI) (AUC = 0.699 and 0.715; all P < 0.05). The CEI displayed similar diagnostic accuracy for ≥ F2 or F4 when using TE (AUC = 0.866 and 0.884, both P > 0.05) or ElastPQ [AUC = 0.751 (P = 0.021) and AUC = 0.786 (P = 0.234)].
The CEI measured by gadoxetic acid-enhanced MRI allows the staging of liver fibrosis, with a diagnostic accuracy comparable to that of TE and superior to that of ElastPQ or APRI.
KeywordsGadoxetic acid Magnetic resonance imaging Liver cirrhosis Fibrosis Elastography
Magnetic resonance imaging
Ultrasound shear wave elastography point quantification
Contrast enhancement index
Liver–spleen contrast ratio
Liver–portal vein contrast ratio
Signal intensity ratio
Area under the receiver operating characteristic curve
Aspartate aminotransferase-to-platelet ratio index
Magnetic resonance elastography
Picture archiving and communication system
Common bile duct
Receiver operating characteristic
We declare no sources of financial support or funding received from any organization including National Institutes of Health (NIH); Wellcome Trust; Howard Hughes Medical Institute (HHMI).
Compliance with ethical standards
Conflict of interest
All author declares that they have no conflict of interest.
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. Informed consent was waived for retrospective nature of clinical and imaging data collection in this study.
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