The diagnostic efficacy of quantitative liver MR imaging with diffusion-weighted, SWI, and hepato-specific contrast-enhanced sequences in staging liver fibrosis—a multiparametric approach
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To assess the diagnostic efficacy of multiparametric MRI using quantitative measurements of the apparent diffusion coefficient (ADC) of the liver parenchyma on diffusion-weighted imaging (DWI), signal intensity (SI) on susceptibility-weighted imaging (SWI), and gadoxetic acid-enhanced T1-weighted imaging during the hepatobiliary phase for the staging of liver fibrosis.
Materials and Methods
Seventy-seven patients underwent a 3T MRI examination, including DWI/SWI sequences and gadoxetic acid-enhanced T1-weighted MRI. Liver fibrosis according to liver biopsy was staged using the Metavir fibrosis score: F0 (n = 21, 27.3 %); F1 (n = 7, 9.1 %); F2 (n = 8, 10.4 %); F3 (n = 12, 15.6 %); and F4 (n = 29, 37.7 %). SI of the liver was defined using region-of-interest measurements to calculate the ADC values, the relative enhancement (RE) in the hepatobiliary phase, and the liver-to-muscle ratio (LMR) measurements for SWI.
The values of RE, LMR, and ADC measurements were statistically significantly different among the five fibrosis stages (p < 0.004). Combining the three parameters in a multiparametric approach, the AUC for detecting F1 stage or greater (≥ F1) was 94 %, for F2 or greater (≥F2) was 95 %, for F3 or greater (≥F3) was 90 %, and for stage F4 was 93 %.
Multiparametric MRI is an efficient non-invasive diagnostic tool for the staging of liver fibrosis.
• Multiparametric MRI has high accuracy in predicting moderate or greater liver fibrosis.
• Relative enhancement post- gadoxetic acid is an independent predictor of liver fibrosis.
• Liver SWI signal intensity and ADC values enhance the diagnostic ability.
KeywordsLiver fibrosis Multiparametric MR imaging Staging Quantitative
The scientific guarantor of this publication is Associate Professor Ahmed Ba-Ssalamah, MD. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board.
Some study subjects or cohorts have been previously reported in the following: Balassy C, Feier D, Peck-Radosavljevic M, et al. Susceptibility-weighted MR Imaging in the Grading of Liver Fibrosis: A Feasibility Study. Radiology. 2014;270(1):149-58, and Feier D, Balassy C, Bastati N, et al. Liver Fibrosis: Histopathologic and Biochemical Influences on Diagnostic Efficacy of Hepatobiliary Contrast-enhanced MR Imaging in Staging. Radiology. 2013.
Methodology: retrospective, diagnostic study, performed at one institution.