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Comparing mono-exponential, bi-exponential, and stretched-exponential diffusion-weighted MR imaging for stratifying non-alcoholic fatty liver disease in a rabbit model

  • Gastrointestinal
  • Published:
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Abstract

Objectives

To compare diffusion parameters obtained from mono-exponential, bi-exponential, and stretched-exponential diffusion-weighted imaging (DWI) in stratifying non-alcoholic fatty liver disease (NAFLD).

Methods

Thirty-two New Zealand rabbits were fed a high-fat/cholesterol or standard diet to obtain different stages of NAFLD before 12 b-values (0–800 s/mm2) DWI. The apparent diffusion coefficient (ADC) from the mono-exponential model; pure water diffusion (D), pseudo-diffusion (D*), and perfusion fraction (f) from bi-exponential DWI; and distributed diffusion coefficient (DDC) and water molecular diffusion heterogeneity index (α) from stretched-exponential DWI were calculated for hepatic parenchyma. The goodness of fit of the three models was compared. NAFLD severity was pathologically graded as normal, simple steatosis, borderline, and non-alcoholic steatohepatitis (NASH). Spearman rank correlation analysis and receiver operating characteristic curves were used to assess NAFLD severity.

Results

Upon comparison, the goodness of fit chi-square from stretched-exponential fitting (0.077 ± 0.012) was significantly lower than that for the bi-exponential (0.110 ± 0.090) and mono-exponential (0.181 ± 0.131) models (p < 0.05). Seven normal, 8 simple steatosis, 6 borderline, and 11 NASH livers were pathologically confirmed from 32 rabbits. Both α and D increased with increasing NAFLD severity (r = 0.811 and 0.373, respectively; p < 0.05). ADC, f, and DDC decreased as NAFLD severity increased (r = − 0.529, − 0.717, and − 0.541, respectively; p < 0.05). Both α (area under the curve [AUC] = 0.952) and f (AUC = 0.931) had significantly greater AUCs than ADC (AUC = 0.727) in the differentiation of NASH from borderline or less severe groups (p < 0.05).

Conclusions

Stretched-exponential DWI with higher fitting efficiency performed, as well as bi-exponential DWI, better than mono-exponential DWI in the stratification of NAFLD severity.

Key Points

• Stretched-exponential diffusion model fitting was more reliable than the bi-exponential and mono-exponential diffusion models (p = 0.039 and p < 0.001, respectively).

• As NAFLD severity increased, the diffusion heterogeneity index (α) increased, while the perfusion fraction (f) decreased (r = 0.811, − 0.717, p < 0.05).

• Both α and f showed superior NASH diagnostic performance (AUC = 0.952, 0.931) compared with ADC (AUC = 0.727, p < 0.05).

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Abbreviations

α :

Diffusion heterogeneity index

ADC:

Apparent diffusion coefficients

AUC:

Area under the curve

D :

Pure water diffusion

D*:

Pseudo-diffusion

DDC:

Distributed diffusion coefficient

DWI:

Diffusion-weighted imaging

f :

Perfusion fraction

HFD:

High-fat/cholesterol diet

MRI:

Magnetic resonance imaging

NAFLD:

Non-alcoholic fatty liver disease

NASH:

Non-alcoholic steatohepatitis

ROI:

Region of interest

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Acknowledgements

We thank Dr. Yuqin Ling from the Department of Pathology, Zhongshan Hospital, Fudan University, for their support of this study.

Funding

This study was funded by the Youth Project from Department of Science and Technology of Jiangsu Province (BK20160450); Top Six Talent Summit Project of Jiangsu Province Human Resources and Social Security Department (2016-WSN-277); Jiangsu Provincial Government Scholarship for Studying Abroad (2018); Jiangsu Provincial Youth Talents Program for Medicine (QNRC2016321); Yangzhou Municipal Youth Talents Program for Medicine (YZZDRC201816).

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Authors and Affiliations

  1. Department of Radiology, Northern Jiangsu People’s Hospital, Clinical Medical School of Yangzhou University, No. 98 Nantong West Road, Yangzhou, 225001, People’s Republic of China

    Chang Li, Jing Ye, Yun Peng, Songan Shang, Jingtao Wu & Xianfu Luo

  2. Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, 510120, People’s Republic of China

    Chang Li

  3. Department of Radiology, Weill Medical College of Cornell University, 407 E 61st Street, New York, NY, 10065, USA

    Martin Prince

  4. GE Healthcare, MR Research China, Bejing, 100176, China

    Weiqiang Dou

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  1. Chang Li
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Correspondence to Xianfu Luo.

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The scientific guarantor of this publication is Xianfu Luo.

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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.

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Approval from the institutional animal care committee was obtained.

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Part of the preliminary results had been published in a Chinese journal (https://doi.org/10.3760/cma.j.issn.0376-2491.2019.07.005). Copyright permission statement was obtained and listed in supplementary materials.

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Li, C., Ye, J., Prince, M. et al. Comparing mono-exponential, bi-exponential, and stretched-exponential diffusion-weighted MR imaging for stratifying non-alcoholic fatty liver disease in a rabbit model. Eur Radiol 30, 6022–6032 (2020). https://doi.org/10.1007/s00330-020-07005-2

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