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Correlation of hepatic fractional extracellular space using gadolinium enhanced MRI with liver stiffness using magnetic resonance elastography

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Abstract

Purpose

To compare MR hepatic fractional extracellular space (fECS) to liver stiffness (LS) with magnetic resonance elastography (MRE) for evaluation of liver fibrosis.

Methods and materials

71 consecutive patients with suspected chronic liver disease underwent standard liver MRI with MR elastography and additional delayed Gd-DTPA-enhanced sequences at 5 and 10 min in order to calculate hepatic fECS (%) and LS (kilopascals, kPa). Two radiologists blinded to clinical history examined MR images and calculated fECS and LS in identical locations for every patient. Interobserver agreement was calculated using the intraclass correlation coefficient. Pearson’s correlation was calculated for LS and fECS measures, as was the area under the receiver operatic curve (AUROC), sensitivity and specificity of fECS to predict liver stiffness ≥2.93 and ≥5 kPa. The sensitivity of fECS for detecting fibrosis was separately analyzed in the subgroup of patients without anatomic findings of cirrhosis.

Results

Substantial to excellent interobserver agreement for both LS and fECS measurements was seen with intraclass correlation of 0.88 (95% CI 0.81–0.92) for LS, 0.77 (95% CI 0.66–0.85) for fECS5 and 0.76 (95% CI 0.64–0.84) for fECS10. A significant correlation was found between MRE and fECS5 (r = 0.47, p < 0.0001) and fECS10 (r = 0.44, p < 0.0001). The performance of fECS improved for detection of advanced fibrosis (≥5 kPa) with AUROC, sensitivity and specificity of 0.72, 38%, and 94% for fECS5 and 0.72, 67%, and 66% for fECS10.

Conclusion

fECS correlates modestly with MRE-determined LS. fECS at MRI is a simple calculation to perform and may represent a practical way to suggest the presence of fibrosis during routine liver evaluation.

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Authors and Affiliations

  1. Department of Radiology, College of Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA

    Michael L. Wells, Michael R. Moynagh, Robert A. Childs, Cameron E. Leitch, Joel G. Fletcher & Sudhakar K. Venkatesh

  2. Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    Rickey E. Carter

  3. Department of Radiology, University of California San Francisco, San Francisco, CA, USA

    Benjamin M. Yeh

Authors
  1. Michael L. Wells
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  2. Michael R. Moynagh
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  3. Rickey E. Carter
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  4. Robert A. Childs
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  5. Cameron E. Leitch
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  6. Joel G. Fletcher
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  8. Sudhakar K. Venkatesh
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Correspondence to Sudhakar K. Venkatesh.

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Ethical approval

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. The study was approved by our institutional review board.

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The requirement for informed consent was waived by our Institutional IRB, due to the retrospective design of the study.

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Wells, M.L., Moynagh, M.R., Carter, R.E. et al. Correlation of hepatic fractional extracellular space using gadolinium enhanced MRI with liver stiffness using magnetic resonance elastography. Abdom Radiol 42, 191–198 (2017). https://doi.org/10.1007/s00261-016-0867-8

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