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Assessment of liver fibrosis with gadoxetic acid-enhanced MRI: comparisons with transient elastography, ElastPQ, and serologic fibrosis markers

  • Hepatobiliary
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Abstract

Objectives

To compare the diagnostic performance of gadoxetic acid-enhanced magnetic resonance imaging (MRI), ultrasonography (US)—based elastography, and serologic fibrosis markers in assessing the stage of liver fibrosis.

Materials and methods

This retrospective study included 67 patients (55 male and 12 female; mean age 62.5 years) who underwent gadoxetic acid-enhanced MRI and liver stiffness measurements before liver biopsy or surgery between January 2014 and January 2018. Measurements were performed using transient elastography (TE), ultrasound shear wave elastography point quantification (ElastPQ), and blood tests. The following MRI-based fibrosis markers were assessed: contrast enhancement index (CEI), liver–spleen contrast ratio (LSC), liver–portal vein contrast ratio (LPC), and signal intensity ratio (SIR). The diagnostic performances of fibrosis markers were compared using the area under the receiver operating characteristic curve (AUC), with histopathologic fibrosis stage as the reference standard.

Results

The fibrosis stages were F0–F1 (n = 17), F2 (n = 7), F3 (n = 20), and F4 (n = 23). MRI-based fibrosis markers negatively correlated with histologic stage: CEI (r = –0.786); LSC (r = − 0.718); LPC (r = − 0.448); and SIR (r = − 0.617; all P < 0.001). For diagnosis of either significant liver fibrosis (≥ F2) or cirrhosis (F4), the CEI provided better diagnostic accuracy (AUC = 0.898 and 0.881) than the aspartate aminotransferase-to-platelet ratio index (APRI) (AUC = 0.699 and 0.715; all P < 0.05). The CEI displayed similar diagnostic accuracy for ≥ F2 or F4 when using TE (AUC = 0.866 and 0.884, both P > 0.05) or ElastPQ [AUC = 0.751 (P = 0.021) and AUC = 0.786 (P = 0.234)].

Conclusions

The CEI measured by gadoxetic acid-enhanced MRI allows the staging of liver fibrosis, with a diagnostic accuracy comparable to that of TE and superior to that of ElastPQ or APRI.

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Abbreviations

MRI:

Magnetic resonance imaging

TE:

Transient elastography

ElastPQ:

Ultrasound shear wave elastography point quantification

CEI:

Contrast enhancement index

LSC:

Liver–spleen contrast ratio

LPC:

Liver–portal vein contrast ratio

SIR:

Signal intensity ratio

AUC:

Area under the receiver operating characteristic curve

APRI:

Aspartate aminotransferase-to-platelet ratio index

US:

Ultrasound

MRE:

Magnetic resonance elastography

AST:

Aspartate aminotransferase

SD:

Standard deviation

HBP:

Hepatobiliary phase

PACS:

Picture archiving and communication system

ROI:

Region-of-interest

CBD:

Common bile duct

SI:

Signal intensity

ROC:

Receiver operating characteristic

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We declare no sources of financial support or funding received from any organization including National Institutes of Health (NIH); Wellcome Trust; Howard Hughes Medical Institute (HHMI).

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Authors and Affiliations

  1. Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea

    Hyeon Ji Jang, Jeong Eun Lee & Kyung Sook Shin

  2. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 06351, Republic of Korea

    Ji Hye Min

  3. Department of Pathology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea

    Kyung-Hee Kim

  4. Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea

    Seo-Youn Choi

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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. Informed consent was waived for retrospective nature of clinical and imaging data collection in this study.

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Supplementary Figure 1. Receiver operating characteristic curves of MRI-based fibrosis markers for differentiating (a) significant liver fibrosis and (b) cirrhosis. Values were based on the liver stiffness measured with the contrast enhancement index (CEI), liver–spleen contrast ratio (LSC), liver–portal vein contrast ratio (LPC), and signal intensity ratio (SIR).

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Jang, H.J., Min, J.H., Lee, J.E. et al. Assessment of liver fibrosis with gadoxetic acid-enhanced MRI: comparisons with transient elastography, ElastPQ, and serologic fibrosis markers. Abdom Radiol 44, 2769–2780 (2019). https://doi.org/10.1007/s00261-019-02041-z

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