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

Abstract

Purpose

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.

Results

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.

Conclusion

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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Abbreviations

ADC :

Apparent diffusion coefficient

ALT:

Alanine amino transferase

AP:

Alkaline phosphatase

AST:

Aspartate amino transferase

DCE :

Dynamic contrast-enhanced

DWI :

Diffusion-weighted imaging

EASL:

European Association for the Study of the Liver

Fa:

Arterial flow

Fi:

Hepatic uptake fraction

FOV:

Field-of-view

Fv:

Portal venous flow

Gd-EOB-DTPA:

Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid

GFR:

Glomerular filtration rate

GGT:

Gamma-glutamyl-transferase

IgG:

Immunoglobulin G

Ki :

Hepatocellular uptake rate

LSM:

Liver stiffness measurements

METAVIR :

Meta-analysis of histological data in viral hepatitis

MRI :

Magnetic resonance imaging

MTT:

Mean transit time

NEX:

Number of excitations

PSC :

Primary sclerosing cholangitis

ROC :

Receiver operating characteristic

ROI:

Region of interest

SD:

Standard deviation

SPIR:

Spectral inversion recovery

TE:

Echo time

TR:

Repetition time

TSE:

Turbo spin echo

Ve:

Extracellular volume

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Funding

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

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Correspondence to S. Keller.

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The scientific guarantor of this publication is J. Yamamura.

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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).

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

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Institutional Review Board approval was obtained.

Methodology

• prospective

• experimental study

• performed at one institution

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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). https://doi.org/10.1007/s00330-018-5614-9

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Keywords

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