Comparison between ROI-based and volumetric measurements in quantifying heterogeneity of liver stiffness using MR elastography

  • Roya Rezvani Habibabadi
  • Pegah Khoshpouri
  • Maryam Ghadimi
  • Mohammadreza Shaghaghi
  • Sanaz Ameli
  • Bita Hazhirkarzar
  • Pallavi Pandey
  • Mounes Aliyari Ghasabeh
  • Ankur Pandey
  • Ihab R. KamelEmail author



This study was conducted to quantify the heterogeneity of liver stiffness (LS) on MR elastography (MRE) by comparing ROI-based and volumetric measurements.


LS was measured by ROI-based and volumetric segmentation of the liver parenchyma. Mean LS (MLS) was calculated and used to assign stages of fibrosis. Volumetric measurements of stiffness maps were used to determine the percentage of liver volume above/below MLS and presence of LS heterogeneity. Heterogeneous stiffness was defined when the first and second most predominant stages were more than one category apart. MLS values by each method were compared using the Wilcoxon signed-rank test.


We included 128 patients with suspected liver fibrosis (mean age 54.4 ± 14.8 years). MLS was 2.7 ± 1.0 kPa for ROI measurements and 2.6 ± 0.9 kPa for the volumetric method (p = 0.001). Of 59 patients with normal stage (F0), 31 patients (52.5%) had > 20% of liver volume with abnormal LS (F1–F4). Heterogeneous LS was reported in 18 patients (14%).


MLS measurement may not represent the entire spectrum of hepatic fibrosis. Volumetric segmentation may potentially improve the detection of heterogeneous fibrosis and the accuracy of LS measurement.

Key Points

• Heterogeneity of hepatic fibrosis may occur in patients with chronic liver disease.

• MR elastography is used to assess hepatic fibrosis by measuring liver stiffness.

• Measuring liver stiffness by the ROI method and reporting a mean value may fail to detect heterogeneity of hepatic fibrosis. Volumetric assessment of liver stiffness by MR elastography may detect heterogeneity of parenchymal involvement.


Magnetic resonance elastography Elastography Liver cirrhosis Fibrosis Elasticity imaging techniques 



Chronic liver diseases


Liver stiffness

MLS stage

Stage of fibrosis assigned to each patient based on mean liver stiffness value of ROIs


Mean liver stiffness


Magnetic resonance elastography


ROI-based segmentation for liver stiffness measurement


Standard deviation


Volumetric segmentation for liver stiffness measurement


Funding information

The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Ihab R Kamel, M.D., Ph.D.

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• Retrospective

• Cross-sectional study diagnostic

• Performed at one institution


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Roya Rezvani Habibabadi
    • 1
  • Pegah Khoshpouri
    • 1
  • Maryam Ghadimi
    • 1
  • Mohammadreza Shaghaghi
    • 1
  • Sanaz Ameli
    • 1
  • Bita Hazhirkarzar
    • 1
  • Pallavi Pandey
    • 1
  • Mounes Aliyari Ghasabeh
    • 1
  • Ankur Pandey
    • 1
  • Ihab R. Kamel
    • 1
    Email author
  1. 1.Russell H. Morgan Department of Radiology and Radiological SciencesJohns Hopkins University School of MedicineBaltimoreUSA

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