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Liver fibrosis: stretched exponential model outperforms mono-exponential and bi-exponential models of diffusion-weighted MRI

European Radiology volume 28, pages 2812–2822 (2018)Cite this article

Abstract

Objectives

To compare the ability of diffusion-weighted imaging (DWI) parameters acquired from three different models for the diagnosis of hepatic fibrosis (HF).

Methods

Ninety-five patients underwent DWI using nine b values at 3 T magnetic resonance. The hepatic apparent diffusion coefficient (ADC) from a mono-exponential model, the true diffusion coefficient (D t ), pseudo-diffusion coefficient (D p ) and perfusion fraction (f) from a biexponential model, and the distributed diffusion coefficient (DDC) and intravoxel heterogeneity index (α) from a stretched exponential model were compared with the pathological HF stage. For the stretched exponential model, parameters were also obtained using a dataset of six b values (DDC#, α#). The diagnostic performances of the parameters for HF staging were evaluated with Obuchowski measures and receiver operating characteristics (ROC) analysis. The measurement variability of DWI parameters was evaluated using the coefficient of variation (CoV).

Results

Diagnostic accuracy for HF staging was highest for DDC# (Obuchowski measures, 0.770 ± 0.03), and it was significantly higher than that of ADC (0.597 ± 0.05, p < 0.001), D t (0.575 ± 0.05, p < 0.001) and f (0.669 ± 0.04, p = 0.035). The parameters from stretched exponential DWI and D p showed higher areas under the ROC curve (AUCs) for determining significant fibrosis (≥F2) and cirrhosis (F = 4) than other parameters. However, D p showed significantly higher measurement variability (CoV, 74.6%) than DDC# (16.1%, p < 0.001) and α# (15.1%, p < 0.001).

Conclusions

Stretched exponential DWI is a promising method for HF staging with good diagnostic performance and fewer b-value acquisitions, allowing shorter acquisition time.

Key Points

• Stretched exponential DWI provides a precise and accurate model for HF staging.

• Stretched exponential DWI parameters are more reliable than D p from bi-exponential DWI model

• Acquisition of six b values is sufficient to obtain accurate DDC and α

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Abbreviations

α:

Alpha, Intravoxel heterogeneity index

α# :

α obtained using a six-b-value dataset (in this study)

CoV:

Coefficient of variation

DDC:

Distributed diffusion coefficient

DDC# :

DDC obtained using a six-b-value dataset (in this study)

D p :

Pseudo-diffusion coefficient

D t :

True diffusion coefficient

f :

Perfusion fraction

HF:

Hepatic fibrosis

IVIM:

Intravoxel incoherent motion

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Funding

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

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Affiliations

  1. Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea

    Nieun Seo, Yong Eun Chung & Myeong-Jin Kim

  2. BK21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea

    Yong Eun Chung

  3. Department of Pathology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea

    Yung Nyun Park

  4. Philips Healthcare Korea, Sowoel-ro 272, Seoul, 04342, Korea

    Eunju Kim & Jinwoo Hwang

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  1. Nieun Seo
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  2. Yong Eun Chung
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  4. Eunju Kim
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Corresponding author

Correspondence to Yong Eun Chung.

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Guarantor

The scientific guarantor of this publication is Yong Eun Chung.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Hyunsoo Yang in Yonsei University Health System performed statistical analysis, and he is not one of the authors.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic study

• performed at one institution

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Seo, N., Chung, Y.E., Park, Y.N. et al. Liver fibrosis: stretched exponential model outperforms mono-exponential and bi-exponential models of diffusion-weighted MRI. Eur Radiol 28, 2812–2822 (2018). https://doi.org/10.1007/s00330-017-5292-z

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  • DOI: https://doi.org/10.1007/s00330-017-5292-z

Keywords

  • Liver
  • Fibrosis
  • Liver cirrhosis
  • Diffusion magnetic resonance imaging