Prospective comparison of diffusion-weighted MRI and dynamic Gd-EOB-DTPA-enhanced MRI for detection and staging of hepatic fibrosis in primary sclerosing cholangitis
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To assess the diagnostic value of multiparametric magnetic resonance imaging (MRI) including dynamic Gd-EOB-DTPA-enhanced (DCE) and diffusion-weighted (DW) imaging for diagnosis and staging of hepatic fibrosis in primary sclerosing cholangitis (PSC) using transient elastography as a standard reference.
Material and methods
Multiparametric MRI was prospectively performed on a 3.0-Tesla scanner in 47 patients (age 43.9±14.3 years). Transient elastography derived liver stiffness measurements (LSM), DCE-MRI derived parameters (hepatocellular uptake rate (Ki), arterial (Fa), portal venous (Fv) and total (Ft) blood flow, mean transit time (MTT), and extracellular volume (Ve)) and the apparent diffusion coefficient (ADC) were calculated. Correlation and univariate analysis of variance with post hoc pairwise comparison were applied to test for differences between LSM derived fibrosis stages (F0/F1, F2/3, F4). ROC curve analysis was used as a performance measure.
Both ADC and Ki correlated significantly with LSM (r= -0.614; p<0.001 and r= -0.368; p=0.01). The ADC significantly discriminated fibrosis stages F0/1 from F2/3 and F4 (p<0.001). Discrimination of F0/1 from F2/3 and F4 reached a sensitivity/specificity of 0.917/0.821 and 0.8/0.929, respectively. Despite significant inter-subject effect for classification of fibrosis stages, post hoc pairwise comparison was not significant for Ki (p>0.096 for F0/1 from F2/3 and F4). LSM, ADC and Ki were significantly associated with serum-based liver functional tests, disease duration and spleen volume.
DW-MRI provides a higher diagnostic performance for detection of hepatic fibrosis and cirrhosis in PSC patients in comparison to Gd-EOB-DTPA-enhanced DCE-MRI.
• Both ADC and hepatocellular uptake rate (Ki) correlate significantly with liver stiffness (r= -0.614; p<0.001 and r= -0.368; p=0.01).
• The DCE-imaging derived quantitative parameter hepatocellular uptake rate (Ki) fails to discriminate pairwise intergroup differences of hepatic fibrosis (p>0.09).
• DWI is preferable to DCE-imaging for discrimination of fibrosis stages F0/1 to F2/3 (p<0.001) and F4 (p<0.001).
KeywordsMagnetic resonance imaging Primary sclerosing cholangitis Liver fibrosis Diffusion magnetic resonance imaging Gadolinium ethoxybenzyl DTPA
Apparent diffusion coefficient
Alanine amino transferase
Aspartate amino transferase
European Association for the Study of the Liver
Hepatic uptake fraction
Portal venous flow
Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid
Glomerular filtration rate
Hepatocellular uptake rate
Liver stiffness measurements
Meta-analysis of histological data in viral hepatitis
Magnetic resonance imaging
Mean transit time
Number of excitations
Primary sclerosing cholangitis
Receiver operating characteristic
Region of interest
Spectral inversion recovery
Turbo spin echo
A.W. Lohse and C. Schramm were funded by the Deutsche Forschungsgemeinschaft (DFG) (SFB841 and KFO306).
Compliance with ethical standards
The scientific guarantor of this publication is J. Yamamura.
Conflict of interest
The authors of this manuscript declare relationships with the following companies: Philips Healthcare (H. Kooijman).
Statistics and biometry
One of the authors has significant statistical expertise (R. Buchert).
Written informed consent was obtained from all subjects in this study.
Institutional Review Board approval was obtained.
• experimental study
• performed at one institution
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