Prospective comparison of diffusion-weighted MRI and dynamic Gd-EOB-DTPA-enhanced MRI for detection and staging of hepatic fibrosis in primary sclerosing cholangitis



To assess the diagnostic value of multiparametric magnetic resonance imaging (MRI) including dynamic Gd-EOB-DTPA-enhanced (DCE) and diffusion-weighted (DW) imaging for diagnosis and staging of hepatic fibrosis in primary sclerosing cholangitis (PSC) using transient elastography as a standard reference.

Material and methods

Multiparametric MRI was prospectively performed on a 3.0-Tesla scanner in 47 patients (age 43.9±14.3 years). Transient elastography derived liver stiffness measurements (LSM), DCE-MRI derived parameters (hepatocellular uptake rate (Ki), arterial (Fa), portal venous (Fv) and total (Ft) blood flow, mean transit time (MTT), and extracellular volume (Ve)) and the apparent diffusion coefficient (ADC) were calculated. Correlation and univariate analysis of variance with post hoc pairwise comparison were applied to test for differences between LSM derived fibrosis stages (F0/F1, F2/3, F4). ROC curve analysis was used as a performance measure.


Both ADC and Ki correlated significantly with LSM (r= -0.614; p<0.001 and r= -0.368; p=0.01). The ADC significantly discriminated fibrosis stages F0/1 from F2/3 and F4 (p<0.001). Discrimination of F0/1 from F2/3 and F4 reached a sensitivity/specificity of 0.917/0.821 and 0.8/0.929, respectively. Despite significant inter-subject effect for classification of fibrosis stages, post hoc pairwise comparison was not significant for Ki (p>0.096 for F0/1 from F2/3 and F4). LSM, ADC and Ki were significantly associated with serum-based liver functional tests, disease duration and spleen volume.


DW-MRI provides a higher diagnostic performance for detection of hepatic fibrosis and cirrhosis in PSC patients in comparison to Gd-EOB-DTPA-enhanced DCE-MRI.

Key Points

• Both ADC and hepatocellular uptake rate (Ki) correlate significantly with liver stiffness (r= -0.614; p<0.001 and r= -0.368; p=0.01).

• The DCE-imaging derived quantitative parameter hepatocellular uptake rate (Ki) fails to discriminate pairwise intergroup differences of hepatic fibrosis (p>0.09).

• DWI is preferable to DCE-imaging for discrimination of fibrosis stages F0/1 to F2/3 (p<0.001) and F4 (p<0.001).

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Fig. 1
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Fig. 6



Apparent diffusion coefficient


Alanine amino transferase


Alkaline phosphatase


Aspartate amino transferase


Dynamic contrast-enhanced


Diffusion-weighted imaging


European Association for the Study of the Liver


Arterial flow


Hepatic uptake fraction




Portal venous flow


Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid


Glomerular filtration rate




Immunoglobulin G

Ki :

Hepatocellular uptake rate


Liver stiffness measurements


Meta-analysis of histological data in viral hepatitis


Magnetic resonance imaging


Mean transit time


Number of excitations


Primary sclerosing cholangitis


Receiver operating characteristic


Region of interest


Standard deviation


Spectral inversion recovery


Echo time


Repetition time


Turbo spin echo


Extracellular volume


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A.W. Lohse and C. Schramm were funded by the Deutsche Forschungsgemeinschaft (DFG) (SFB841 and KFO306).

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Corresponding author

Correspondence to S. Keller.

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The scientific guarantor of this publication is J. Yamamura.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Philips Healthcare (H. Kooijman).

Statistics and biometry

One of the authors has significant statistical expertise (R. Buchert).

Informed consent

Written informed consent was obtained from all subjects in this study.

Ethical approval

Institutional Review Board approval was obtained.


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Keller, S., Sedlacik, J., Schuler, T. et al. Prospective comparison of diffusion-weighted MRI and dynamic Gd-EOB-DTPA-enhanced MRI for detection and staging of hepatic fibrosis in primary sclerosing cholangitis. Eur Radiol 29, 818–828 (2019).

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  • Magnetic resonance imaging
  • Primary sclerosing cholangitis
  • Liver fibrosis
  • Diffusion magnetic resonance imaging
  • Gadolinium ethoxybenzyl DTPA