Abstract
Background
We prospectively examined unenhanced MR imaging findings in relation to pathologic fibrosis, inflammation and steatosis in patients with compensated chronic hepatitis C viral infection (HCV).
Methods
Unenhanced MRI at 1.5 T was obtained within one month of core liver biopsy in 64 consecutive candidates for antiviral therapy for compensated HCV. Two pathologists independently graded inflammatory activity index (HAI) and steatosis, and staged fibrosis (grades 0–6). Morphologic MRI findings of cirrhosis, periportal lymph nodes, and MR fat signal ratio from dual gradient echo images were assessed independently by two radiologists blinded to clinical data. MRI and laboratory liver function results were correlated with pathologic results, using Spearman correlation coefficient and stepwise multiple regression.
Results
MR fat signal ratio correlation coefficient with pathologic steatosis was 0.71 (p < 0.0001). Coefficients with fibrosis stage were highest for surface nodularity (r s = 47, p < 0.0001) and expanded gallbladder fossa (r s = 0.42, p = 0.0006). Coefficients with HAI were highest for lymph node size (r s = 0.355, p = 0.0040), surface nodularity (r = 0.47, p < 0.0001), expanded gallbladder fossa (r = 0.332, p = 0.0073), and caudate/right lobe ratio (r = 0.326, p = 0.0110). Combined lab and MRI variables provided the best prediction of fibrosis stage (r 2 = 0.656) and HAI (r 2 = 0.597).
Conclusions
A combination of MRI and laboratory findings was most predictive of fibrosis and inflammation.
Similar content being viewed by others
References
Armstrong GL, Wasley A, Simard EP, et al. (2006) The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med 144:705–714
Lauer GM, Walker BD, Hepatitis C (2001) virus infection. N Engl J Med 345:41–52
DiBisceglie AM, Thompson J, Smith-Wilkaitis N, et al. (2001) Combination of interferon and ribavirin in chronic hepatitis C: re-treatment of nonre-sponders to interferon. Hepatology 33:704–707
Kisloff B (2001) Periodic liver biopsy for mild hepatitis C. Ann Intern Med 135:381–382
Brunt EM (2000) Grading and staging the histopathological lesions of chronic hepatitis: the Knodell histology activity index and beyond. Hepatology 31:241–246
Kirn AI, Saab S (2005) Treatment of hepatitis C. Am J Med 18:808–815
Strader DB, Wright T, Thomas DL et al. (2004) Diagnosis, management, and treatment of hepatitis C. Hepatology 39:1147–1171
Herrine SK (2002) Approach to the patient with chronic hepatitis C virus infection. Ann Intern Med 136:747–757
Farrell RJ, Smiddy PF, Pilkington RM, et al. (1999) Guided versus blind liver biopsy for chronic hepatitis C: clinical benefits and costs. J Hepatol 30:580–587
Maharaj B, Bhoora IG (1992) Complications associated with percutaneous needle biopsy of the liver when one, two or three specimens are taken. Postgrad Med J 68:964–967
Janes CH, Lindor KD (1993) Outcome of patients hospitalized for complications after outpatient liver biopsy. Ann Intern Med 18:96–98
Alberti A, Noventa F, Benvegnu L, Boccato S, Gatta A (2002) Prevalence of liver disease in a population of asymptomatic persons with hepatitis C virus infection. Ann Intern Med 137:961–964
Chuah SY, Moody GA, Wicks AC, et al. (1994) A nationwide survey of liver biopsy—is there a need to increase resources, manpower and training? Hepatogastroenterology 41:4–8
Regev A, Berho M, Jeffers LJ, et al. (2002) Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol 97:2614–2618
Bedossa P, Dargere D, Paradis V (2003) Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology 38:1449–1457
Taouli B, Losada M, Holland A, et al. (2004) Magnetic resonance imaging of hepato-cellular carcinoma. Gastroenterology 127:S144–152
Murakami T, Mochizuki K, Nakamura H (2001) Imaging evaluation of the cirrhotic liver. Semin Liver Dis 21:213–224
Semelka RC, Chung JJ, Hussain SM, Marcos HB, Woosley JT (2001) Chronic hepatitis: correlation of early patchy and late linear enhancement patterns on gadolinium-enhanced MR images with histopathology initial experience. J Magn Reson Imaging 13:385–391
Aguirre DA, Behling CA, Alpert E, Hassanein TI, Sirlin CB (2006) Liver fibrosis: noninvasive diagnosis with double contrast material-enhanced MR imaging. Radiology 239:425–437
Cho SG, Kirn MY, Kirn HJ, et al. (2001) Chronic hepatitis: in vivo proton MR spectroscopic evaluation of the liver and correlation with histopathologic findings. Radiology 221:740–746
Koinuma M, Ohashi I, Hanafusa K, et al. (2005) Apparent diffusion coefficient measurements with diffusion-weighted magnetic resonance imaging for evaluation of hepatic fibrosis. J Magn Reson Imaging 22:80–85
Pandharipande PV, Krinsky GA, Rusinek H, et al. (2005) Perfusion imaging of the liver: current challenges and future goals. Radiology 234:661–673
Lafortune M, Matricardi L, Denys A, et al. (1998) Segment 4 (the quadrate lobe): a barometer of cirrhotic liver disease at US. Radiology 206:157–160
Harbin WP, Robert NJ, Ferrucci JT (1980) Diagnosis of cirrhosis based on regional changes in hepatic morphology: a radiological and pathological analysis. Radiology 135:273–283
Mitchell DG, Lovett KE, Hann HW, et al. (1993) Cirrhosis: multiobserver analysis of hepatic MR imaging findings in a heterogeneous population. J Magn Reson Imaging 3:313–321
Awaya H, Mitchell DG, Kamishima T, et al. (2002) Cirrhosis: modified caudate-right lobe ratio. Radiology 224:769–774
Ito K, Mitchell DG, Gabata T, et al. (1999) Expanded gallbladder fossa: simple MR imaging sign of cirrhosis. Radiology 211:723–726
Ito K, Mitchell DG, Gabata T (2000) Enlargement of hilar periportal space: a sign of early cirrhosis at MR imaging. J Magn Reson Imaging 11:136–140
Choi MS, Lee JH, Koh KC, et al (2001) Clinical significance of enlarged perihepatic lymph nodes in chronic hepatitis B. J Clin Gastroenterol 32:329–332
Dietrich CF, Lee JH, Herrmann G et al. (1997) Enlargement of perihepatic lymph nodes in relation to liver histology and viremia in patients with chronic hepatitis C. Hepatology 26:467–472
Soresi M, Carroccio A, Agate V, et al. (1999) Evaluation by ultrasound of abdominal lymphadenopathy in chronic hepatitis C. Am J Gastroenterol 94:497–501
Wedemeyer H, Ockenga J, Frank H, et al. (1998) Perihepatic lymphadenopathy: a marker of response to interferon alpha in chronic hepatitis C. Hepatogastroenterology 45:1062–1068
Zhang XM, Mitchell DG, Shi H, et al. (2002) Chronic hepatitis C activity: correlation with lymphadenopathy on MR imaging. AJR Am J Roentgenol 179:417–422
Ishak K, Baptista A, Bianchi, L et al. (1995) Histological grading and staging of chronic hepatitis. J Hepatol 22:696–699
Lefkowitch JH, Schiff ER, Davis GL, et al. (1993) Pathological diagnosis of chronic hepatitis C: a multicenter comparative study with chronic hepatitis B. The Hepatitis Interventional Therapy Group. Gastroenterology 104:595–603
Leandro G, Mangia A, Hui J, et al. (2006) Relationship between steatosis, inflammation, and fibrosis in chronic hepatitis C: a meta-analysis of individual patient data. Gastroenterology l30:l636–l642
Mitchell DG, Crovello M, Matteucci T, et al. (1992) Benign adreno-cortical masses: diagnosis with chemical shift MR imaging. Radiology 185:345–351
Mitchell DG, Kim I, Chang TS, et al. (1991) Fatty liver: chemical shift saturation and phase-difference MR imaging techniques in animals, phantoms and humans. Invest Radiol 26:1041–1052
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mitchell, D.G., Navarro, V.J., Herrine, S.K. et al. Compensated hepatitis C: unenhanced MR imaging correlated with pathologic grading and staging. Abdom Imaging 33, 58–64 (2008). https://doi.org/10.1007/s00261-007-9203-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-007-9203-7